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Hoven E, Michelet JT, Vettore MV, Lagali N. Choroidal thickness after anti-VEGF in typical neovascular age-related macular degeneration - A systematic review and meta-analysis. Surv Ophthalmol 2024:S0039-6257(24)00124-3. [PMID: 39374696 DOI: 10.1016/j.survophthal.2024.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 09/24/2024] [Accepted: 09/24/2024] [Indexed: 10/09/2024]
Abstract
Age-related macular degeneration (AMD) is one of the leading causes of blindness in the world and anti-vascular endothelial growth factor (VEGF) injections have been the standard of care for the wet/neovascular variant since 2004. Currently, there are conflicting reports regarding its effect on the choroid, which supplies outer retina with oxygen and other nutrients. We synthesize available information of anti-VEGF on choroidal thickness (CT) in treatment-naïve typical neovascular AMD patients during the initial 12-week loading phase. We found 43 studies involving 1901 eyes from 1878 patients were included. Meta-analysis of 35 studies reporting CT at baseline and after 12 weeks suggested a significant decrease in CT with anti-VEGF treatment. A greater mean change with aflibercept compared to ranibizumab was found in subgroup analyses of sub-foveal CT in types 1 and 2 macular neovascularization. The long-term consequences of reduced CT in neovascular AMD remain unclear and require further targeted studies.
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Affiliation(s)
- Erlend Hoven
- Department of Ophthalmology, Sorlandet Hospital, Norway; Department of Health and Nursing Sciences, University of Agder, Norway.
| | | | - Mario V Vettore
- Department of Health and Nursing Sciences, University of Agder, Norway
| | - Neil Lagali
- Department of Ophthalmology, Sorlandet Hospital, Norway; Department of Biomedical and Clinical Sciences, Linköping University, Sweden
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Wang D, Xiao H, Lin S, Fang L, Gan Y, Zhang Y, Chen X, Huang Z, Zheng S, Shi H, Xu Z, Li Y, Li J, Liu X, Zuo C. Comparison of the Choroid in Primary Open Angle and Angle Closure Glaucoma Using Optical Coherence Tomography. J Glaucoma 2023; 32:e137-e144. [PMID: 37671543 DOI: 10.1097/ijg.0000000000002303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 08/17/2023] [Indexed: 09/07/2023]
Abstract
PRCIS The current study highlights distinct choroidal alterations in primary open angle (POAG) and primary angle closure (PACG) glaucomas, underscoring the potential of the Choroidal Vascularity Index (CVI) as a valuable indicator for understanding glaucoma pathogenesis. PURPOSE To evaluate choroidal structural changes in patients with POAG and PACG and healthy controls utilizing the CVI and subfoveal choroidal thickness by enhanced depth imaging optical coherence tomography. METHODS This study was cross-sectional. A total of 171 eyes of 171 subjects, comprising 69 eyes with untreated POAG, 58 eyes with untreated PACG, and 44 healthy eyes, were enrolled in this study. Subfoveal choroidal thickness, luminal area (LA), stromal area (SA), and total choroidal area were measured on enhanced depth imaging-optical coherence tomography scans. The CVI parameter is calculated as the proportion of LA to the total choroidal area. RESULTS This study included 69 patients with POAG with a mean age of 51.4 ± 13.3 years, 58 patients with PACG with a mean age of 57.0 ± 7.3 years, and 44 healthy subjects with a mean age of 51.11 ± 10.7 years. The CVI in the POAG and PACG groups was significantly lower than that in the control group ( P = 0.001 and P = 0.005, respectively); however, not significantly different between the two glaucoma groups ( P = 1.000). POAG eyes had significantly lower LA than PACG and controls ( P = 0.014 and P = 0.049, respectively), whereas PACG eyes had significantly greater SA than controls ( P = 0.041). CONCLUSIONS The CVI of POAG and PACG eyes was significantly lower than that of normal eyes. A reduced LA was observed mainly in eyes with POAG, and an increased SA was observed mainly in eyes with PACG. The role of the choroid may differ between POAG and PACG eyes.
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Affiliation(s)
- Dingqiao Wang
- Department of Glaucoma, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science
- Guangdong Provincial Clinical Research Center for Ocular Diseases
| | - Hui Xiao
- Department of Glaucoma, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science
- Guangdong Provincial Clinical Research Center for Ocular Diseases
| | - Shufen Lin
- Department of Glaucoma, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science
- Guangdong Provincial Clinical Research Center for Ocular Diseases
| | - Lei Fang
- Department of Glaucoma, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science
- Guangdong Provincial Clinical Research Center for Ocular Diseases
| | - Yuhong Gan
- Department of Glaucoma, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science
- Guangdong Provincial Clinical Research Center for Ocular Diseases
| | - Yuxin Zhang
- Department of Ophthalmology, The First Affiliated Hospital of Kunming Medical University, Kunming Yunnan
| | - Xiangxi Chen
- Aier School of Ophthalmology, Wuhan Aier Eye Hospital, Central South University, Wuhan, China
| | - Zhihong Huang
- Department of Glaucoma, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science
- Guangdong Provincial Clinical Research Center for Ocular Diseases
| | - Shaoyang Zheng
- Department of Glaucoma, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science
- Guangdong Provincial Clinical Research Center for Ocular Diseases
| | - Huanyang Shi
- Department of Glaucoma, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science
- Guangdong Provincial Clinical Research Center for Ocular Diseases
| | - Zixing Xu
- Zhongshan School of Medicine Sun Yat-sen University Guangzhou, Guangzhou
| | - Yixuan Li
- Zhongshan School of Medicine Sun Yat-sen University Guangzhou, Guangzhou
| | - Junyi Li
- Zhongshan School of Medicine Sun Yat-sen University Guangzhou, Guangzhou
| | - Xing Liu
- Department of Glaucoma, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science
- Guangdong Provincial Clinical Research Center for Ocular Diseases
| | - Chengguo Zuo
- Department of Glaucoma, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science
- Guangdong Provincial Clinical Research Center for Ocular Diseases
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Bora K, Kushwah N, Maurya M, Pavlovich MC, Wang Z, Chen J. Assessment of Inner Blood-Retinal Barrier: Animal Models and Methods. Cells 2023; 12:2443. [PMID: 37887287 PMCID: PMC10605292 DOI: 10.3390/cells12202443] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 10/07/2023] [Accepted: 10/08/2023] [Indexed: 10/28/2023] Open
Abstract
Proper functioning of the neural retina relies on the unique retinal environment regulated by the blood-retinal barrier (BRB), which restricts the passage of solutes, fluids, and toxic substances. BRB impairment occurs in many retinal vascular diseases and the breakdown of BRB significantly contributes to disease pathology. Understanding the different molecular constituents and signaling pathways involved in BRB development and maintenance is therefore crucial in developing treatment modalities. This review summarizes the major molecular signaling pathways involved in inner BRB (iBRB) formation and maintenance, and representative animal models of eye diseases with retinal vascular leakage. Studies on Wnt/β-catenin signaling are highlighted, which is critical for retinal and brain vascular angiogenesis and barriergenesis. Moreover, multiple in vivo and in vitro methods for the detection and analysis of vascular leakage are described, along with their advantages and limitations. These pre-clinical animal models and methods for assessing iBRB provide valuable experimental tools in delineating the molecular mechanisms of retinal vascular diseases and evaluating therapeutic drugs.
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Affiliation(s)
| | | | | | | | | | - Jing Chen
- Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
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Rosenfeld PJ, Cheng Y, Shen M, Gregori G, Wang RK. Unleashing the power of optical attenuation coefficients to facilitate segmentation strategies in OCT imaging of age-related macular degeneration: perspective. BIOMEDICAL OPTICS EXPRESS 2023; 14:4947-4963. [PMID: 37791280 PMCID: PMC10545179 DOI: 10.1364/boe.496080] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/22/2023] [Accepted: 07/27/2023] [Indexed: 10/05/2023]
Abstract
The use of optical attenuation coefficients (OAC) in optical coherence tomography (OCT) imaging of the retina has improved the segmentation of anatomic layers compared with traditional intensity-based algorithms. Optical attenuation correction has improved our ability to measure the choroidal thickness and choroidal vascularity index using dense volume scans. Algorithms that combine conventional intensity-based segmentation with depth-resolved OAC OCT imaging have been used to detect elevations of the retinal pigment epithelium (RPE) due to drusen and basal laminar deposits, the location of hyperpigmentation within the retina and along the RPE, the identification of macular atrophy, the thickness of the outer retinal (photoreceptor) layer, and the presence of calcified drusen. OAC OCT algorithms can identify the risk-factors that predict disease progression in age-related macular degeneration.
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Affiliation(s)
- Philip J. Rosenfeld
- Department of Ophthalmology, Bascom Palmer
Eye Institute, University of Miami Miller School of
Medicine, Miami, Florida, USA
| | - Yuxuan Cheng
- Department of Bioengineering,
University of Washington, Seattle,
Washington, USA
| | - Mengxi Shen
- Department of Ophthalmology, Bascom Palmer
Eye Institute, University of Miami Miller School of
Medicine, Miami, Florida, USA
| | - Giovanni Gregori
- Department of Ophthalmology, Bascom Palmer
Eye Institute, University of Miami Miller School of
Medicine, Miami, Florida, USA
| | - Ruikang K. Wang
- Department of Bioengineering,
University of Washington, Seattle,
Washington, USA
- Department of Ophthalmology,
University of Washington, Seattle,
Washington, USA
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Zhang J, Mazlin V, Fei K, Boccara AC, Yuan J, Xiao P. Time-domain full-field optical coherence tomography (TD-FF-OCT) in ophthalmic imaging. Ther Adv Chronic Dis 2023; 14:20406223231170146. [PMID: 37152350 PMCID: PMC10161339 DOI: 10.1177/20406223231170146] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 03/29/2023] [Indexed: 05/09/2023] Open
Abstract
Ocular imaging plays an irreplaceable role in the evaluation of eye diseases. Developing cellular-resolution ophthalmic imaging technique for more accurate and effective diagnosis and pathogenesis analysis of ocular diseases is a hot topic in the cross-cutting areas of ophthalmology and imaging. Currently, ocular imaging with traditional optical coherence tomography (OCT) is limited in lateral resolution and thus can hardly resolve cellular structures. Conventional OCT technology obtains ultra-high resolution at the expense of a certain imaging range and cannot achieve full field of view imaging. In the early years, Time-domain full-field OCT (TD-FF-OCT) has been mainly used for ex vivo ophthalmic tissue studies, limited by the low speed and low full-well capacity of existing two-dimensional (2D) cameras. The recent improvements in system design opened new imaging possibilities for in vivo applications thanks to its distinctive optical properties of TD-FF-OCT such as a spatial resolution almost insensitive to aberrations, and the possibility to control the curvature of the optical slice. This review also attempts to look at the future directions of TD-FF-OCT evolution, for example, the potential transfer of the functional-imaging dynamic TD-FF-OCT from the ex vivo into in vivo use and its expected benefit in basic and clinical ophthalmic research. Through non-invasive, wide-field, and cellular-resolution imaging, TD-FF-OCT has great potential to be the next-generation imaging modality to improve our understanding of human eye physiology and pathology.
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Affiliation(s)
- Jinze Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Viacheslav Mazlin
- ESPCI Paris, PSL University, CNRS, Langevin Institute, Paris, France
| | - Keyi Fei
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | | | - Jin Yuan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Jinsui Road 7, Guangzhou 510060, Guangdong, China
| | - Peng Xiao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Jinsui Road 7, Guangzhou 510060, Guangdong, China
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Guler Alis M, Alis A. Choroidal vascularity index in adults with different refractive status. Photodiagnosis Photodyn Ther 2021; 36:102533. [PMID: 34520880 DOI: 10.1016/j.pdpdt.2021.102533] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/07/2021] [Accepted: 09/10/2021] [Indexed: 11/24/2022]
Abstract
AIM We aimed to perform structural analysis of the choroid in adults with different refractive status. MATERIALS AND METHODS A prospective, comparative study of 100 right eyes of 100 patients ages 18-40 years was conducted. The patients were divided into four groups according to spherical equivalent (SE): Group 1: -0.5 and above, low-to-moderate myopia; Group 2: -6 and above, high myopia; Group 3: +0.5 and above, hyperopia; Group 4: +/- 0.5, emmetropia. With the images obtained using enhanced depth imaging optical coherence tomography (EDI-OCT), the total choroidal area (TCA), luminal area (LA), stromal area (SA), and choroidal vascular index (CVI) were calculated using the binarization method. The anterior chamber depth (ACD), axial length (AL), and central corneal thickness (CCT) values were measured by optical biometry. All parameters were compared between groups. The correlation of biometric parameters with CVI was examined. RESULTS Parameters were found to be statistically different between the four groups. TCA, LA, and SA values were the highest in Group 3 and lowest in Group 2. L/S ratio and CVI values in Group 3 were significantly lower than in the other groups. There was a negative correlation between AL with SE and CT, and no correlation between the CVI and other parameters. CONCLUSION CVI decreases when emmetropization is disrupted and changes to hypermetropia or myopia. The reason for the decrease in myopia is the reduction of the luminal area, while in hyperopia it is due to an increase in the stromal area. When there is a shift toward myopia, there is a decrease in the TCA, but the CVI does not change significantly. Unlike CT, the CVI is not affected by factors such as SE and AL; therefore, the CVI can be a useful parameter for examining choroidal changes in refractive errors.
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Affiliation(s)
- Meryem Guler Alis
- Fatih Sultan Mehmet Training and Research Hospital, Atasehir, Istanbul, Turkey.
| | - Abdulkadir Alis
- Fatih Sultan Mehmet Training and Research Hospital, Atasehir, Istanbul, Turkey
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OCT Biomarkers in Neovascular Age-Related Macular Degeneration: A Narrative Review. J Ophthalmol 2021; 2021:9994098. [PMID: 34336265 PMCID: PMC8313359 DOI: 10.1155/2021/9994098] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 07/13/2021] [Indexed: 12/13/2022] Open
Abstract
Age-related macular degeneration (AMD) is the leading cause of legal blindness in elderly people. Neovascular AMD (nAMD) is responsible for the majority of cases of severe visual loss in eyes with AMD. Optical coherence tomography (OCT) is the most widely used technology for the diagnosis and follow-up of nAMD patients, which is widely used to study and guide the clinical approach, as well as to predict and evaluate treatment response. The aim of this review is to describe and analyze various structural OCT-based biomarkers, which have practical value during both initial assessment and treatment follow-up of nAMD patients. While central retinal thickness has been the most common and one of the first OCT identified biomarkers, today, other qualitative and quantitative biomarkers provide novel insight into disease activity and offer superior prognostic value and better guidance for tailored therapeutic management. The key importance of retinal fluid compartmentalization (intraretinal fluid, subretinal fluid, and subretinal pigment epithelium (RPE) fluid) will be discussed firstly. In the second part, the structural alterations of different retinal layers in various stages of the disease (photoreceptors layer integrity, hyperreflective dots, outer retinal tubulations, subretinal hyperreflective material, and retinal pigment epithelial tears) will be analyzed in detail. The last part of the review will focus on how alterations of the vitreoretinal interface (vitreomacular adhesion and traction) and of the choroid (sub-RPE hyperreflective columns, prechoroidal clefts, choroidal caverns, choroidal thickness and choroidal volume, and choroidal vascular index) interact with nAMD progression. OCT technology is evolving very quickly, and new retinal biomarkers are continuously described. This up-to-date review article provides a comprehensive description on how structural OCT-based biomarkers provide a valuable tool to monitor the progression of the disease and the treatment response in nAMD patients. Thus, in this perspective, clinicians will be able to allocate hospital resources in the best possible way and tailor treatment to the individual patient's needs.
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OCT Based Interpretation of the Optic Nerve Head Anatomy and Prevalence of Optic Disc Drusen in Patients with Idiopathic Intracranial Hypertension (IIH). Life (Basel) 2021; 11:life11060584. [PMID: 34205357 PMCID: PMC8234108 DOI: 10.3390/life11060584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/07/2021] [Accepted: 06/17/2021] [Indexed: 12/19/2022] Open
Abstract
We aimed to systematically examine the optic nerve head anatomy in patients with idiopathic intracranial hypertension (IIH) using a standardized optical coherence tomography (OCT) protocol. The study retrospectively included 32 patients diagnosed from 2014 to 2021 with IIH. Using OCT, in accordance with a standardized scanning protocol for patients with optic disc drusen, the presence of optic disc drusen, prelaminar hyperreflective lines, peripapillary hyperreflective ovoid mass-like structures, the retinal nerve fiber layer thickness, and macular ganglion cell layer volume was obtained. Optic disc drusen were found in 3.1%, hyperreflective lines in 31.3%, and peripapillary hyperreflective ovoid mass-like structures in 81.3% of all IIH patients at least three months after the time of diagnosis. We found no significant differences in retinal nerve fiber layer thickness or macular ganglion cell layer volume in patients with hyperreflective lines or PHOMS respectively compared to patients without hyperreflective lines (p = 0.1285 and p = 0.1835). In conclusion, the prevalence of optic disc drusen in IIH patients is similar to the reported prevalence in the general population. The high prevalence of hyperreflective lines and peripapillary hyperreflective ovoid mass-like structures in IIH patients suggest these structures be a result of crowding in the optic nerve head caused by papilledema.
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