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Ip MS, Scott IU, VanVeldhuisen PC, Oden NL, Blodi BA. Month 60 Imaging Findings and Relationship to Treatment Outcomes Following Anti-VEGF Therapy for Macular Edema Due to Central or Hemi-Retinal Vein Occlusion. Am J Ophthalmol 2024; 260:147-159. [PMID: 38061584 DOI: 10.1016/j.ajo.2023.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 01/21/2024]
Abstract
PURPOSE To evaluate imaging findings from SCORE2 participants through 60 months, to describe the degree of resolution or progression of these variables, and to correlate changes in these imaging findings to treatment outcomes such as visual acuity and the number of treatments administered. METHODS SCORE2 participants were followed for up to 60 months. Visual acuity, injection frequency and imaging tests color fundus photography (CFP), optical coherence tomography (OCT), and ultra-widefield fluorescein angiography [UWFA]) were performed throughout this period. RESULTS Less than 6% of eyes had subretinal fluid at month 60. Disorganization of the retinal inner layers (DRIL) was the most likely finding to persist, present in 96% of eyes at baseline and unchanged at 95% at month 60. For UWFA, at baseline, there was a mean of 5.0% non-perfusion area (95% CI: 3.3%-6.8%) in the NETWORC grid with little change to month 60. For the Early Treatment Diabetic Retinopathy Study (ETDRS) grid, at baseline, there was a mean of 2.3% non-perfusion area (95% CI: 0.7%-3.9%) with little change to month 60. There was no correlation between any of the imaging variables at baseline and change in visual acuity to month 60 or in the number of injections following the variable treatment timeframe (month 12 to month 60). CONCLUSIONS These analyses provide an anatomic explanation for persistent functional deficits many years following initial treatment. Clinical practice patterns should consider evaluation with these imaging tests to help explain persistent functional deficits in many eyes. Additionally, these 8 baseline imaging variables generally should not be relied on to predict visual acuity or intensity of treatment. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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Affiliation(s)
- Michael S Ip
- From the Doheny Eye Institute (M.S.I.), University of California-Los Angeles, Los Angeles, California, USA.
| | - Ingrid U Scott
- Departments of Ophthalmology and Public Health Sciences (I.U.S.), Penn State College of Medicine, Hershey, Pennsylvania, USA
| | | | - Neal L Oden
- The Emmes Company, LLC (P.C.V., N.L.O.), Rockville, Maryland, USA
| | - Barbara A Blodi
- University of Wisconsin Reading Center (B.A.B.), Madison, Wisconsin, USA
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Kim YH, Yun C, Oh J. Integrity of the Hyperreflective Layer in the Inner Choroid in Eyes with Drusen. Ophthalmol Ther 2024; 13:529-540. [PMID: 38113024 PMCID: PMC10787704 DOI: 10.1007/s40123-023-00865-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 11/23/2023] [Indexed: 12/21/2023] Open
Abstract
INTRODUCTION This study aimed to compare the integrity of the hyperreflective layer of the inner choroid in eyes with and without drusen. METHODS Swept-source optical coherence tomography images of patients with drusen and normal controls were reviewed. Using a line plot of ImageJ, choroidal reflectivity was measured at the subfovea, and the integrity of the hyperreflective layer of the inner choroid was determined. RESULTS In total, 63 eyes with drusen and 30 control eyes without drusen were included. The integrity of the hyperreflective layer of the inner choroid was preserved in 81.0% of eyes with drusen and 93.3% of normal controls. The proportion of eyes with the hyperreflective layer did not differ between eyes with and without drusen. Of the 63 subjects with drusen, this hyperreflective layer was observed in all 28 eyes (100%) with pachydrusen but only in 68.6% of the 35 eyes with soft drusen, and its prevalence was significantly different (P = 0.001). CONCLUSION The prevalence of the hyperreflective layer between the choriocapillaris and medium or large choroidal vessels in eyes with soft drusen differed from that in eyes with pachydrusen. These findings support the suggestion that changes within the choroidal stroma may be involved in the pathogenesis of age-related macular degeneration.
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Affiliation(s)
- Young Ho Kim
- Department of Ophthalmology, Korea University College of Medicine, 73 Goryeodae-ro Sungbuk-ku, Seoul, 02841, Korea
| | - Cheolmin Yun
- Department of Ophthalmology, Korea University College of Medicine, 73 Goryeodae-ro Sungbuk-ku, Seoul, 02841, Korea
| | - Jaeryung Oh
- Department of Ophthalmology, Korea University College of Medicine, 73 Goryeodae-ro Sungbuk-ku, Seoul, 02841, Korea.
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Au A, Ip M, Blodi BA, Scott IU, Oden NL, Van Veldhuisen PC, Sarraf D. OCT Grading System of Macular Infarction Predicts Vision in Participants With Central Retinal or Hemiretinal Vein Occlusion: A Secondary Analysis of SCORE2. Am J Ophthalmol 2023; 256:55-62. [PMID: 37544495 PMCID: PMC11040591 DOI: 10.1016/j.ajo.2023.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 07/28/2023] [Accepted: 07/30/2023] [Indexed: 08/08/2023]
Abstract
PURPOSE To determine whether macular infarction measured as hyper-reflectivity of the middle and inner retinal layers predicts long-term visual acuity outcomes in participants with central retinal vein occlusion (CRVO) or hemi-retinal vein occlusion (HRVO). DESIGN Clinical cohort study using post hoc secondary analysis of phase 3 clinical trial data. METHODS This post hoc secondary analysis of the phase 3 Study of COmparative Treatments for REtinal Vein Occlusions 2 (SCORE2) clinical trial included 310 of the 362 participants with macular edema secondary to CRVO/HRVO who were randomized to injections of aflibercept or bevacizumab. Month 01 (M01) optical coherence tomography (OCT) images were analyzed using the following grading scheme: no infarction (grade 0), only middle retinal infarction (grade 1), diffuse middle and patchy inner retinal infarction (grade 2), and diffuse middle and inner retinal infarction (grade 3). Visual acuity letter score (VALS), central subfield thickness (CST), and number of anti-vascular endothelial growth factor (anti-VEGF) injections were correlated with the infarction severity grade at month 01. RESULTS More severe macular infarction, with both middle and inner retinal layer hyper-reflectivity (ie, grades 2 and 3), was associated with worse M00 VALS and was predictive of VALS at M01 to M60 (P < .001). More severe infarction was associated with greater CST at presentation; however, after the first anti-VEGF injection, CST decreased and was similar across all grades at all time points (P > .05) with similar number of injections. CONCLUSIONS Participants with more severe macular infarction at M01, as graded with OCT, exhibited worse visual outcomes despite significantly improved macular edema from month 6 to 5 years. This suggests that macular infarction may drive visual acuity after retinal fluid is treated with anti-VEGF.
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Affiliation(s)
- Adrian Au
- Stein Eye Institute (A.A., D.S.), University of California, Los Angeles, California, USA
| | - Michael Ip
- Doheny Image Reading Center (M.I.), Doheny Eye Institute, Los Angeles, California, USA
| | - Barbara A Blodi
- Department of Ophthalmology and Visual Sciences (B.A.B.), University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Ingrid U Scott
- Departments of Ophthalmology and Public Health Sciences (I.U.S.), Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Neal L Oden
- The Emmes Company, LLC (N.L.O., P.C.V.V.), Rockville, Maryland, USA
| | | | - David Sarraf
- Stein Eye Institute (A.A., D.S.), University of California, Los Angeles, California, USA; VA Greater Los Angeles Healthcare System (D.S.), Los Angeles, California, USA.
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Hwang BE, Kim JY, Kim RY, Kim M, Park YG, Park YH. Alteration of perivascular reflectivity on optical coherence tomography of branched retinal vein obstruction. Sci Rep 2023; 13:15847. [PMID: 37739970 PMCID: PMC10517127 DOI: 10.1038/s41598-023-41691-4] [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: 03/31/2023] [Accepted: 08/30/2023] [Indexed: 09/24/2023] Open
Abstract
This study aimed to evaluate perivascular reflectivity in patients with branched retinal vascular obstruction (BRVO) using en-face optical coherence tomography (OCT). The study retrospectively analyzed 45 patients with recurrent BRVO, 30 with indolent BRVO, and 45 age- and sex-matched controls. Using a 3.0 × 3.0-mm deep capillary plexus slab on macular scans, OCT angiography (OCTA) and structural en-face OCT scans were divided into four quadrants. Obstructive quadrants of OCTA scans were binarized using a threshold value of mean + 2 standard deviation. The selected area of high signal strength (HSS) was applied to the structural en-face OCT scans, and the corrected mean perivascular reflectivity was calculated as the mean reflectivity on the HSS area/overall en-face OCT mean reflectivity. The same procedure was performed in the quadrants of the matched controls. Regression analysis was conducted on several factors possibly associated with corrected perivascular reflectivity. The perivascular reflectivity in the obstructive BRVO quadrant was significantly higher than in the indolent BRVO and control quadrants (P = 0.009, P = 0.003). Both univariate and multivariate regression analyses showed a significant correlation between the average number of intravitreal injections (anti-vascular endothelial growth factor or dexamethasone implant) per year and refractive errors and image binarization threshold and perivascular reflectivity (P = 0.011, 0.013, < 0.001/univariate; 0.007, 0.041, 0.005/multivariate, respectively). En-face OCT scans of the deep capillary plexus slab revealed higher perivascular reflectivity in recurrent BRVO eyes than in indolent BRVO and control eyes. The results also indicate a remarkable correlation between perivascular reflectivity and the average number of intravitreal injections, suggesting a link to recurrence rates.
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Affiliation(s)
- Bo-Een Hwang
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
- Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joo-Young Kim
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
- Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Rae-Young Kim
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
- Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Mirinae Kim
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
- Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young-Geun Park
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
- Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young-Hoon Park
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
- Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Mehta N, Patil S, Modi V, Vardi R, Liu K, Singh RP, Sarraf D, Oden NL, VanVeldhuisen PC, Scott IU, Ip MS, Blodi BA, Modi Y. High Variation in Inner Retinal Reflectivity Predicts Poor Visual Outcome in Patients With Central Retinal Vein Occlusion: SCORE2 Report 21. Transl Vis Sci Technol 2023; 12:21. [PMID: 37367722 DOI: 10.1167/tvst.12.6.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
Purpose To assess the association of a novel spectral domain optical coherence tomography biomarker with 6-month visual acuity in in the Study of COmparative Treatments for REtinal Vein Occlusion 2. Methods Spectral domain optical coherence tomography volume scans were evaluated for inner retinal hyperreflectivity, quantified by optical intensity ratio (OIR) and OIR variation. Baseline visual acuity letter score (VALS), baseline OCT biomarkers, and month 1 OIR were correlated with VALS at month 6. Regression trees, a machine learning technique yielding readily interpretable models, were used to assess for variable interaction. Results Only baseline VALS correlated positively with month 6 VALS in multivariate regression. Regression trees detected a novel functional and anatomical interaction in a subgroup. Among patients with a baseline VALS worse than 43, those with an OIR variation at month 1 of more than 0.09 had a mean of 13 fewer letters of vision at 6 months compared with patients with an OIR variation of 0.09 or less. Conclusions Baseline VALS was the strongest predictor of month 6 VALS. Regression tree analysis detected an interaction effect, in which higher OIR variation at month 1 predicted worse 6-month VALS in patients with low VALS at baseline. OIR variation may serve as a predictor for poor visual outcome despite treatment of macular edema secondary to retinal vein occlusion in patients with poor vision at baseline. Translational Relevance Pixel heterogeneity in three-dimensional OCT data may serve as measure of disruption of the retinal laminations, and this factor may carry visually prognostic value.
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Affiliation(s)
- Nitish Mehta
- Department of Ophthalmology, NYU Langone Health, New York University, New York, NY, USA
| | - Sachi Patil
- Department of Ophthalmology, NYU Langone Health, New York University, New York, NY, USA
| | - Vikram Modi
- Department of Ophthalmology, NYU Langone Health, New York University, New York, NY, USA
| | - Rachel Vardi
- Department of Ophthalmology, NYU Langone Health, New York University, New York, NY, USA
| | - Kevin Liu
- Department of Ophthalmology, NYU Langone Health, New York University, New York, NY, USA
| | - Rishi P Singh
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, The Cleveland Clinic, Cleveland, OH, USA
| | - David Sarraf
- Department of Ophthalmology, University of California - Los Angeles, Los Angeles, CA, USA
- Jules Stein Eye Institute, Los Angeles, CA, USA
| | | | | | - Ingrid U Scott
- Departments of Ophthalmology and Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Michael S Ip
- Doheny Eye Institute, University of California, Los Angeles, CA, USA
| | - Barbara A Blodi
- University of Wisconsin Fundus Photograph Reading Center, Madison, WI, USA
| | - Yasha Modi
- Department of Ophthalmology, NYU Langone Health, New York University, New York, NY, USA
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Siedlecki J, Hattenbach LO, Feltgen N, Priglinger SG. [Biomarkers in the treatment of retinal vein occlusion]. DIE OPHTHALMOLOGIE 2022; 119:1111-1120. [PMID: 36201041 DOI: 10.1007/s00347-022-01732-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Retinal vein occlusion, subdivided into central retinal and branch retinal vein occlusion, is one of the most frequent vascular diseases of the retina. Biomarkers of optical coherence tomography (OCT), OCT-angiography and (ultra-widefield) fluorescein angiography are of exceptional importance in the initial diagnosis and also in the treatment of complications associated with retinal vascular occlusion, particularly macular edema. METHODS A systematic literature review was carried out in PubMed with the keywords central retinal vein occlusion, branch retinal vein occlusion, biomarker, OCT, OCT angiography, ultra-widefield fluorescein angiography with prioritization of the most important aspects. RESULTS Relevant biomarkers in OCT include central retinal thickness (CRT), macular fluid, the integrity of the photoreceptor bands (external limiting membrane and ellipsoid zone), disorganization of retinal inner layers (DRIL), hyperreflective foci, choroidal thickness and signs of ischemia, such as a prominent middle limiting membrane (p-MLM), paracentral acute middle maculopathy (PAMM) as well as hyperreflectivity of inner retinal layers (HIRL). The importance of OCT-angiography lies particularly in the assessment of microvascular alterations, especially vessel density in the deep retinal vascular plexus, the foveal avascular zone and of areas with no capillary perfusion. Biomarkers of ultra-widefield angiography, such as peripheral ischemia (ischemic index) and neovascularízation are essential with respect to treatment decisions for retinal laser. CONCLUSION A multitude of simple and complex biomarkers currently enable an effective individualized evaluation of treatment and prognosis in retinal vein occlusion. A shift from invasive to noninvasive biomarkers can be observed.
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Affiliation(s)
- Jakob Siedlecki
- Augenklinik und Poliklinik, Klinikum der Ludwig-Maximilians-Universität München, Mathildenstr. 8, 80336, München, Deutschland.
| | | | - Nikolas Feltgen
- Augenklinik, Georg-August-Universität Göttingen Universitätsmedizin, Göttingen, Deutschland
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Association of inner retinal reflectivity with qualitative and quantitative changes in retinal layers over time in diabetic eyes without retinopathy. Eye (Lond) 2022; 36:1253-1260. [PMID: 34117378 PMCID: PMC9151723 DOI: 10.1038/s41433-021-01607-w] [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: 08/22/2020] [Revised: 05/05/2021] [Accepted: 05/13/2021] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To assess the course of neurodegeneration based on retinal layer thickness and integrity analysis in diabetic patients without retinopathy and to evaluate its association with inner retinal reflectivity. METHODS This retrospective case-control study included 80 eyes of 80 patients with DM without retinopathy and 40 eyes of 40 healthy subjects with a follow-up of ≥1 year. SD-OCT was used for assessment of retinal reflectivity and macular layer thicknesses. Optical intensity ratios (OIRs) were defined as the mean OCT reflectivity of ganglion cell and inner nuclear layer to the mean reflectivity of RPE. RESULTS After Bonferroni correction, thinning in pericentral, superior and nasal sectors in total retina, superior ganglion cell, pericentral and nasal inner plexiform, and superior inner retinal layers, as well as thickening in inferior and pericentral outer plexiform layer remained significant in the study group (p < 0.0125). Ganglion cell layer OIR significantly correlated with the changes in superior retina (r = 0.278, p = 0.013), central inner retina (r = 0.247, p = 0.027), and pericentral retinal thickness (r = 0.240, p = 0.032), and no eyes had disruption of retinal layers in the study group initially or finally. CONCLUSION Ganglion cell layer reflectivity significantly correlated with the amount of pericentral retinal thinning during the time course in the diabetic group, which was more prominent in the inner retinal layers.
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Cicinelli MV, Sadiq SA, Mishra S, Jampol LM, Mirza RG. Multimodal Imaging Characterization of Arteriolosclerotic Plaques in Retinal Vein Occlusion. Ophthalmic Surg Lasers Imaging Retina 2021; 52:650-657. [PMID: 34908486 DOI: 10.3928/23258160-20211118-01] [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: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVES To investigate the multimodal imaging features and the clinical associations of arteriolosclerotic plaques in patients with retinal vein occlusion (RVO). MATERIALS AND METHODS This was a retrospective case series of patients with RVO. Demographic and clinical characteristics were recorded at the time of RVO for each participant. Best-corrected visual acuity and central macular thickness were collected at baseline and observed for 1 year. Arteriolosclerotic plaques were identified on multimodal imaging, and their imaging features were summarized. Differences in demographic and clinical characteristics between eyes with arteriolosclerotic plaques and those with no arteriolosclerotic plaques were reported. RESULTS Seventy-five eyes of 75 patients (39 males; mean age, 72.5 years) were included. Arteriolosclerotic plaques were identified in nine eyes (12%) as segmental, yellow, ill-defined creamy lesions in the arterioles' walls. Baseline macular edema was worse in eyes with arteriolosclerotic plaques than in eyes with no plaques (716.5 μm vs 539.7 μm). Arteriolosclerotic plaques did not interfere with blood flow and regressed in three eyes (33%). Eyes with plaques had worse best-corrected visual acuity (P < .001) and lower central macular thickness (P = .02) at 12 months than did eyes with RVO and no plaques. CONCLUSIONS Arteriolosclerotic plaques suggest an ischemic or inflammatory involvement of the arteriolar branches in eyes with RVO and are associated with severe macular damage. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:650-657.].
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Etheridge T, Blodi B, Oden N, Van Veldhuisen P, Scott IU, Ip MS, Mititelu M, Domalpally A. Spectral Domain OCT Predictors of Visual Acuity in the Study of COmparative Treatments for REtinal Vein Occlusion 2: SCORE 2 Report 15. Ophthalmol Retina 2020; 5:991-998. [PMID: 33373715 DOI: 10.1016/j.oret.2020.12.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/07/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the association between baseline demographic and spectral domain OCT (SD-OCT) features with visual acuity (VA) in the Study of COmparative Treatments for REtinal Vein Occlusion 2 (SCORE2) over 2 years. DESIGN Post hoc analysis of prospective clinical trial data. PARTICIPANTS A total of 362 SCORE2 participants with macular edema secondary to central retinal (CRVO) or hemiretinal vein occlusion (HRVO). METHODS Spectral domain OCT volume scans were assessed at the SCORE2 reading center at baseline, month 01 (M01), month 06 (M06), month 12 (M12), and month 24 (M24) for central subfield thickness (CST), subretinal fluid, intraretinal fluid, vitreoretinal interface abnormalities, disorganization of retinal inner layers (DRIL), and ellipsoid zone (EZ) within the central subfield (CSF). MAIN OUTCOME MEASURES Visual acuity at M06, M12, and M24. RESULTS Mean baseline age was 68.9 years. Mean VA at M01 was 63.2 letters, and CST was 299.7 μm. At M01, subretinal fluid was seen in 28.5% intraretinal fluid in 67.2%, DRIL was seen in 73.8%, mostly within the CSF, and the EZ was absent in 9.8 and patchy in 31.7%. In multivariate analysis including all M01 demographics and SD-OCT parameters and their association with VA at M06, M12, and M24, VA at M01 remained significant across all time points up to M24 (P < 0.001). CONCLUSIONS In this 2-year follow-up of eyes that were treated with both per protocol and off protocol for RVO, VA at M01 was an important predictor of long-term vision and change in vision. Establishing predictors of visual recovery helps identify causes for poor responders to treatment in patients with RVO.
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Affiliation(s)
- Tyler Etheridge
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Barbara Blodi
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Neal Oden
- The Emmes Company, LLC, Rockville, Maryland
| | | | - Ingrid U Scott
- Departments of Ophthalmology and Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Michael S Ip
- Doheny Eye Institute, University of California Los Angeles Stein Eye Institute, Los Angeles, California
| | - Mihai Mititelu
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Amitha Domalpally
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
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Cheloni R, Denniss J. Depth-resolved variations in visibility of retinal nerve fibre bundles across the retina in enface OCT images of healthy eyes. Ophthalmic Physiol Opt 2020; 41:179-191. [PMID: 33150636 DOI: 10.1111/opo.12756] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 09/17/2020] [Accepted: 09/17/2020] [Indexed: 01/30/2023]
Abstract
PURPOSE Recent developments in optical coherence tomography (OCT) technology enable direct enface visualisation of retinal nerve fibre bundle (RNFB) loss in glaucoma. However, the optimum depth at which to visualise RNFBs across the retina is unknown. We aimed to evaluate the range of depths and optimum depth at which RNFBs can be visualised across the retina in healthy eyes. METHODS The central ± 25° retina of 10 healthy eyes from 10 people aged 57-75 years (median 68.5 years) were imaged with spectral domain OCT. Slab images of maximum axial resolution (4 μm) containing depth-resolved attenuation coefficients were extracted from 0 to 193.5 μm below the inner limiting membrane (ILM). Bundle visibility within 10 regions of a superimposed grid was assessed subjectively by trained optometrists (n = 8), according to written instructions. Anterior and posterior limits of RNFB visibility and depth of best visibility were identified for each grid sector. Effects of retinal location and individual eye on RNFB visibility were explored using linear mixed modelling with likelihood ratio tests. Intraclass correlation coefficient (ICC) was used to measure overall agreement and repeatability of grading. Spearman's correlation was used to measure correlation between depth range of visible RNFBs and retinal nerve fibre layer thickness (RNFLT). RESULTS Retinal location and individual eye affected anterior limit of visibility (χ2 (9) = 58.6 and 60.5, both p < 0.0001), but none of the differences exceeded instrument resolution, making anterior limit consistent across the retina and different eyes. Greater differences were observed in the posterior limit of visibility across retinal areas (χ2 (9) = 1671.1, p < 0.0001) and different eyes (χ2 (9) = 88.7, p < 0.0001). Optimal depth for visualisation of RNFBs was around 20 µm below the ILM in most regions. It varied slightly with retinal location (χ2 (9) = 58.8, p < 0.0001), but it was not affected by individual eye (χ2 (9) = 10.7, p = 0.29). RNFB visibility showed good agreement between graders (ICC 0.89, 95%CI 0.87-0.91), and excellent repeatability (ICC 0.96-0.99). Depth range of visible RNFBs was highly correlated with RNFLT (ρ = 0.9, 95%CI: 0.86-0.95). CONCLUSIONS The range of depths with visible RNFBs varies markedly across the healthy retina, consistently with RNFLT. To extract all RNFB information consistently across the retina, slab properties should account for differences across retinal locations and between individual eyes.
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Affiliation(s)
- Riccardo Cheloni
- School of Optometry and Vision Science, University of Bradford, Bradford, UK
| | - Jonathan Denniss
- School of Optometry and Vision Science, University of Bradford, Bradford, UK
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11
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Risseeuw S, Bennink E, Poirot MG, de Jong PA, Spiering W, Imhof SM, van Leeuwen R, Ossewaarde-van Norel J. A Reflectivity Measure to Quantify Bruch's Membrane Calcification in Patients with Pseudoxanthoma Elasticum Using Optical Coherence Tomography. Transl Vis Sci Technol 2020; 9:34. [PMID: 32855880 PMCID: PMC7422762 DOI: 10.1167/tvst.9.8.34] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 05/19/2020] [Indexed: 12/12/2022] Open
Abstract
Purpose Progressive calcification of Bruch's membrane (BM) causes considerable visual morbidity in patients with pseudoxanthoma elasticum (PXE). Since calcification is hyperreflective on optical coherence tomography (OCT), our aim was to measure BM calcification with OCT imaging. Methods Case-control study with 45 patients with PXE under 40 years (range, 11-39) and 25 controls (range, 14-39). Spectralis HRA-OCT imaging consisted of seven macular B-scans with 250-µm spacing. Retinal segmentation was performed with the IOWA Reference Algorithms. MATLAB was used to extract and average z-axis reflectivity profiles. Layer reflectivities were normalized to the ganglion cell and inner plexiform layers. Both median and peak layer reflectivities were compared between patients with PXE and controls. The discriminative value of the retinal pigment epithelium (RPE)-BM peak reflectivity was analyzed using receiver operating characteristic analysis. Results The reflectivity profile of patients with PXE differed from controls in the outer retinal layers. The normalized median RPE-BM reflectivity was 41.1 (interquartile range [IQR], 26.3-51.9) in patients with PXE, compared with 22.5 (IQR, 19.3-29.5) in controls (P = 2.09 × 10-3). The normalized RPE-BM peak reflectivity was higher in patients with PXE (67.5; IQR, 42.1-84.2) than in controls (32.7; IQR, 25.7-38.9; P = 2.43 × 10-5) and had a high discriminative value with an area under the curve of 0.85 (95% confidence interval, 0.76-0.95). In patients with PXE under 40 years, increasing age did not have a statistically significant effect on the RPE-BM peak reflectivity (patients under 20 years: 44.2 [IQR, 40.5-74.6]; 20-30 years: 66.0 [IQR, 45.1-83.8]; 30-40 years: 70.8 [IQR, 49.0-88.0], P = 0.47). Conclusions BM calcification can be measured as increased RPE-BM reflectivity in young patients with PXE and has a high discriminative value. Translational Relevance In patients with PXE, the OCT reflectivity of Bruch's membrane may be the first biomarker for Bruch's membrane calcification and a valuable ophthalmologic endpoint in clinical trials.
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Affiliation(s)
- Sara Risseeuw
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Edwin Bennink
- Image Sciences Institute, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Maarten G Poirot
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Wilko Spiering
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Saskia M Imhof
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Redmer van Leeuwen
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Ozer MD, Batur M, Mesen S, Tekin S, Seven E. Evaluation of the Initial Optical Coherence Tomography Parameters in Anticipating the Final Visual Outcome of Central Retinal Vein Occlusion. J Curr Ophthalmol 2020; 32:46-52. [PMID: 32510013 PMCID: PMC7265274 DOI: 10.4103/joco.joco_47_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 10/21/2019] [Accepted: 11/10/2019] [Indexed: 11/04/2022] Open
Abstract
Purpose To evaluate the predictive and associated factors in determining the visual outcome in patients having central retinal vein occlusion (CRVO)-related macular edema (ME). Methods The charts of the patients who were treated due to CRVO-related visual disturbance were reviewed. The optical coherence tomography (OCT) images of eyes were analyzed, and disorganization of retinal inner layers (DRILs), ellipsoid zone (EZ) and external limiting membrane (ELM) disruption length, hyper-reflectivity of retinal inner layer (HRIL) existence, baseline and final visual acuity (VA), subfoveal thickness (SFT), subretinal fluid (SRF), and injection numbers were noted. The regression and correlation analyses were applied. Results Thirty eyes of thirty patients were included in the study. The mean follow-up time was 17.5 ± 11 (8-47) months. The mean baseline VA was 1.4 ± 0.7 (0.2-3.1) logMAR. A total of 87 intravitreal injections were applied for the treatment of ME during the follow-up. The initial mean central subfield thickness was 795 ± 264 (1470-398) μm. HRIL and SRF were observed in 16 and 23 eyes at the initial visit, respectively. The final mean VA was 1.2 ± 0.9 (0.1-3.1) logMAR. At the final visit, additional OCT parameters were evaluated. The mean DRIL length was 463 ± 324 μm. The mean disruption length of EZ and ELM was 367 ± 247 μm and 414 ± 327 μm, respectively. The final mean SFT was 290 ± 91 μm. SRF presence at the initial visit was found to be associated with elongated EZ and ELM disruption length at the final visit (P = 0.03 and P = 0.04, respectively). On linear regression analyses, none of the baseline features (SRF, SFT, and HRIL) except baseline poor best corrected visual acuity were found to be predictive in anticipating the final visual outcome (P = 0.04). On linear bivariate analysis, the final poor visual outcome was found to be affected by EZ disruption length of ≥500 μm at the last visit (P = 0.02). Conclusion Baseline VA was the only predictive factor in anticipating the final visual outcome. At the final visit, extensive disruption length of EZ in the subfoveal area was associated with a poor visual outcome.
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Affiliation(s)
- Muhammet Derda Ozer
- Department of Ophthalmology, Faculty of Medicine, Van Yuzuncu Yil University, Tusba, Van, Turkey
| | - Muhammed Batur
- Department of Ophthalmology, Faculty of Medicine, Van Yuzuncu Yil University, Tusba, Van, Turkey
| | - Selma Mesen
- Department of Ophthalmology, Faculty of Medicine, Van Yuzuncu Yil University, Tusba, Van, Turkey
| | - Serek Tekin
- Department of Ophthalmology, Faculty of Medicine, Van Yuzuncu Yil University, Tusba, Van, Turkey
| | - Erbil Seven
- Department of Ophthalmology, Faculty of Medicine, Van Yuzuncu Yil University, Tusba, Van, Turkey
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Greenlee TE, Cutler NE, Mehta N, Hom GL, Wai K, Conti FF, Conti TF, Bena JF, Modi Y, Singh RP. Inner Retinal Layer Reflectivity as Predictor of Retinal Vein Occlusion Visual Acuity Outcomes. Ophthalmol Retina 2019; 4:343-344. [PMID: 31810899 DOI: 10.1016/j.oret.2019.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 09/20/2019] [Accepted: 09/27/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Tyler E Greenlee
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Nitish Mehta
- Department of Ophthalmology, New York University, New York, New York
| | - Grant L Hom
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Karen Wai
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Felipe F Conti
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Thais F Conti
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - James F Bena
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Yasha Modi
- Department of Ophthalmology, New York University, New York, New York
| | - Rishi P Singh
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Case Western Reserve University School of Medicine, Cleveland, Ohio.
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In vivo analysis and comparison of anterior segment structures of both eyes in unilateral Fuchs’ uveitis syndrome. Graefes Arch Clin Exp Ophthalmol 2019; 257:1489-1498. [DOI: 10.1007/s00417-019-04351-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 04/17/2019] [Accepted: 05/02/2019] [Indexed: 12/17/2022] Open
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