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Kalogeropoulos D, Rahman N, Afshar F, Hall N, Lotery AJ. Punctate inner choroidopathy: A review of the current diagnostic and therapeutic approaches. Prog Retin Eye Res 2024; 99:101235. [PMID: 38181975 DOI: 10.1016/j.preteyeres.2023.101235] [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: 10/26/2023] [Revised: 12/27/2023] [Accepted: 12/29/2023] [Indexed: 01/07/2024]
Abstract
Punctate inner choroidopathy (PIC) is an uncommon idiopathic inflammatory condition characterized by multifocal chorioretinopathy that primarily affects young adults, with a predilection for myopic females. Clinically, it manifests as small, yellowish-white lesions in the inner choroid and outer retina, often associated with inflammatory changes. Accurate diagnosis remains a challenge due to its resemblance to other posterior uveitic entities, necessitating an astute clinical eye and advanced imaging techniques for differentiation. Multimodal imaging plays a crucial role by offering valuable insights, as it enables the visualization of various abnormalities related to uveitis. The pathogenesis of PIC is still a subject of debate, with a complex interplay of genetic, immunological, and environmental factors proposed. Managing PIC presents multiple challenges for clinicians. Firstly, variable disease severity within and among patients requires diverse treatments, from observation to aggressive immunosuppression and/or anti-VEGF therapy. Secondly, treatment must distinguish between primary causes of vision loss. New or worsening PIC lesions suggest active inflammation, while new neovascular membranes may indicate secondary neovascular processes. Thirdly, deciding on maintenance therapy is complex, balancing PIC prognosis variability against immunosuppression risks. Some patients have long periods of inactivity and remission, while others face sudden, vision-threatening episodes during quiescent phases. Through a systematic review of the literature, this paper sheds light on the current understanding of PIC, its challenges, and the prospects for future research. By synthesizing existing knowledge, it aims to aid clinicians in accurate diagnosis and guide treatment decisions for improved visual outcomes in individuals affected by PIC.
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Affiliation(s)
| | - Najiha Rahman
- Southampton Eye Unit, University Hospital Southampton, Southampton, United Kingdom
| | - Farid Afshar
- Southampton Eye Unit, University Hospital Southampton, Southampton, United Kingdom
| | - Nigel Hall
- Southampton Eye Unit, University Hospital Southampton, Southampton, United Kingdom
| | - Andrew John Lotery
- Southampton Eye Unit, University Hospital Southampton, Southampton, United Kingdom; Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
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COMPARISON OF PRIMARY AND SECONDARY FORMS OF MULTIPLE EVANESCENT WHITE DOT SYNDROME. Retina 2022; 42:2368-2378. [DOI: 10.1097/iae.0000000000003609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Alsarhani WK, Al Adel FF, Alamri A, Al Malawi RM, AlBloushi AF. Alterations in ocular microcirculation and oxygen metabolism in patients with lipemia retinalis. BMC Ophthalmol 2022; 22:295. [PMID: 35794613 PMCID: PMC9258117 DOI: 10.1186/s12886-022-02515-7] [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: 04/04/2022] [Accepted: 06/29/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Purpose
The study aims to assess the alterations in retinal oxygen saturation and retinal and choroidal blood flow in lipemia retinalis.
Methods
This was a cross-sectional study on 10 eyes (5 patients) with history of lipemia retinalis. The study comprised 10 eyes with documented history of lipemia retinalis and 10 participants as healthy controls. Patients with a confirmed history of lipemia retinalis were grouped into two cohorts based on their most recent fundus examination: untreated lipemia retinalis (abnormal fundus) and resolved lipemia retinalis (normal fundus). Both retinal arteriolar and venular oxygen saturation were measured using the non-invasive spectrophotometric retinal oximeter (Oxymap T1). The mean blur rate (MBR) of the optic nerve and choroidal blood flow were analyzed using a laser speckle flowgraph (LSFG).
Results
Patients with untreated lipemia retinalis had a significantly higher retinal arteriolar and venular oxygen saturation than that of the other two groups (p < 0.001). Moreover, patients with untreated lipemia retinalis had significantly smaller retinal arteriolar and venular diameters (p < 0.001). On LSFG, there was a significant difference in the overall MBR (p = 0.007) and vessel MBR of the optic nerve between the groups (p = 0.011). The patients with history of lipemia retinalis (untreated and resolved) exhibited a high overall MBR and vessel MBR of the optic nerve than that of the control group. There was a significant elevation of the optic nerve (p = 0.002) and choroidal blowout score (p < 0.001), while the resistivity index of the optic nerve (p = 0.001) and choroids (p = 0.002) was significantly lower in patients with resolved and untreated lipemia retinalis.
Conclusions
There was a significant alteration in retinal oximetry, in untreated lipemia retinalis, and in retinal blood flow, in both the resolved and untreated groups. The increase in retinal blood flow and oxygen saturation may elucidate the preservation of visual acuity and function despite the fundus changes observed in lipemia retinalis.
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Clinical Study of Intravitreal Injection of Anti-VEGF Drugs Combined with Triamcinolone Acetonide in the Treatment of Coats Disease. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:9911549. [PMID: 35756410 PMCID: PMC9232298 DOI: 10.1155/2022/9911549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 05/03/2022] [Indexed: 11/17/2022]
Abstract
Objective To investigate the clinical study of intravitreal injection of anti-VEGF drugs combined with intravitreal injection of tretinoin for the treatment of Coats disease. Methods The medical records of 90 patients (120 eyes) with Coats disease admitted to our hospital from April 2010 to June 2021 were selected as retrospective study subjects and divided into control and treatment groups according to the numerical table method. There were 45 cases and 60 eyes in each group. Among them, intravitreal tretinoin drug was injected into the control group, and anti-VEGF drug was injected into the vitreous sclera of the treatment group on the basis of the control group. Results Before treatment, the differences in visual acuity changes between the two groups were not statistically significant (P > 0.05). After treatment, the light perception, manipulation, and indexes of both groups were significantly improved, and the treatment group was significantly better than the control group. This difference was statistically significant (P < 0.05) for statistical study comparison. The effective rate of 95.56% in the treatment group was significantly higher than that of 86.67% in the control group, and the complication rate was significantly lower than that of the control group, with statistically significant differences (P < 0.05). Conclusion Intravitreal injection of anti-VEGF drugs combined with tretinoin injection can significantly improve the clinical efficacy of patients with Coats disease and improve visual acuity and central retinal thickness, which has certain reference value for the clinical treatment of Coats disease.
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Steptoe PJ, Pearce I, Beare NAV, Sreekantam S, Mohammed BR, Barry RJ, Steeples LR, Denniston AK, Murray PI. Proposing a Neurotropic Etiology for Acute Posterior Multifocal Placoid Pigment Epitheliopathy and Relentless Placoid Chorioretinitis. FRONTIERS IN OPHTHALMOLOGY 2022; 1:802962. [PMID: 38983970 PMCID: PMC11182168 DOI: 10.3389/fopht.2021.802962] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/20/2021] [Indexed: 07/11/2024]
Abstract
Purpose To reassess the underlying pathophysiology of acute posterior multifocal placoid pigment epitheliopathy (APMPPE) and relentless placoid chorioretinitis (RPC) through comparison with the non-inoculated eye of the von Szily animal model of neurotropic viral retinal infection. Methods Narrative review. Results Literature reports of isolated neurotropic viral entities and rising serological viral titers in APMPPE after presentation support a potential direct infective etiology. In general, viral transport along axons results in mitochondrial stasis and disruption of axoplasmic flow. Clinical manifestations of axoplasmic flow disruption in APMPPE/RPC may signify the passage of virus along the neuronal pathway. From a case series of 11 patients, we demonstrate a timely, spatial, and proportional association of optic disc swelling with APMPPE lesion occurrence. Signs within the inner retina appear to precede outer retinal lesions; and acute areas of outer nuclear layer (ONL) hyperreflectivity appear to be the result of coalescence of multiple hyperreflective foci resembling axonal spheroids (which occur as a consequence of axoplasmic disruption) and follow the Henle fiber layer neurons. Underlying areas of retinal pigment epithelium (RPE) hyper-autofluorescence follow ONL hyperreflectivity and may signify localized infection. Areas of apparent choriocapillaris hypoperfusion mirror areas of RPE/Bruch's membrane separation and appear secondary to tractional forces above. Increases in choroidal thickness with lesion occurrence and focal areas of choriocapillaris hypoperfusion are observed in both APMPPE/RPC and the von Szily model. Conclusions The neurotrophic infection model provides significant advantages over the existing primary choriocapillaris ischemia hypothesis to account for the range of imaging signs observed in APMPPE and RPC.
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Affiliation(s)
- Paul J Steptoe
- Princess Alexandra Eye Pavilion, Edinburgh, United Kingdom
| | - Ian Pearce
- St. Paul's Eye Unit, Liverpool University Hospitals National Health Service (NHS) Foundation Trust, Liverpool, United Kingdom
| | - Nicholas A V Beare
- St. Paul's Eye Unit, Liverpool University Hospitals National Health Service (NHS) Foundation Trust, Liverpool, United Kingdom
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | | | | | - Robert J Barry
- Birmingham and Midland Eye Centre, Birmingham, United Kingdom
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Laura R Steeples
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, United Kingdom
| | - Alastair K Denniston
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- Ophthalmology Department, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Centre for Rare Diseases, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Philip I Murray
- Birmingham and Midland Eye Centre, Birmingham, United Kingdom
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
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Papasavvas I, Neri P, Mantovani A, Herbort CP. Idiopathic multifocal choroiditis (MFC): aggressive and prolonged therapy with multiple immunosuppressive agents is needed to halt the progression of active disease. An offbeat review and a case series. J Ophthalmic Inflamm Infect 2022; 12:2. [PMID: 35001171 PMCID: PMC8743334 DOI: 10.1186/s12348-021-00278-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND PURPOSE Idiopathic multifocal choroiditis (MFC) is part of the group of choriocapillaritis entities. The clinical definition of the disease has evolved with time. The aim of this article was to undertake a review on MFC, on its present-day appraisal and nomenclature and we also report a series of patients with emphasis on the clinical presentation and the importance of vigorous immunosuppressive management. METHODS A review of the literature and a retrospective case series study which was performed in the Centre for Ophthalmic Specialised care (COS), Lausanne, Switzerland. Patients diagnosed from 1994 to 2020 with idiopathic multifocal choroiditis (MFC) treated with multiple immunosuppressants were included. Exclusion criteria were insufficient follow up and cases not treated with vigorous immunosuppressive therapy. Imaging analysis included spectral domain optical coherence tomography (SD-OCT) / enhanced depth imaging OCT (EDI-OCT), OCT angiography (OCT-A). Fluorescein and Indocyanine angiography (FA, ICGA) before and after the instauration of treatment. Best corrected visual acuity (BCVA), intraocular pressure (IOP), routine ocular examination, laser flare photometry (LFP) were performed at presentation and follow-up. Immunosuppression comprised at minimum two among the following agents: prednisone, cyclosporine, azathioprine, mycophenolic acid or infliximab. Mean duration of therapy was calculated. RESULTS 26 (52 eyes) of 2102 new patients (1.24%) were diagnosed with MFC. 25 (96%) patients were female and 1 (4%) was male. 43/52 (82%) eyes were myopic with a mean dioptre of - 5.87 ± 2.94, six (12%) eyes were hypermetropic with mean dioptres 2.0 ± 2.68 and three (6%) were emmetropic. 14/52 (27%) eyes had at least 1 anti-VEGF injection because of choroidal neovascularisation (CNVs), 1 eye had a phototherapy laser and 37/52 (71%) had no complication of CNVs during the follow-up. 5/26 (19%) fulfilled the inclusion criteria for our study. Mean age was 26.4 ± 9.3 years. Snellen best corrected visual acuity (BCVA) at presentation was 0.955+/-0.26. Mean follow up was 84+/-55 months. LFP at presentation was 6.34 ± 2.94 ph/ms. None of four patients with prolonged treatment and prolonged follow-up showed disease activity. One patient still under therapy after 4 months' follow-up still showed an active neovascular membrane. CONCLUSION Treatment with multiple immunosuppressive agents was shown to stop the progression of the disease.
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Affiliation(s)
- Ioannis Papasavvas
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Rue Charles-Monnard 6, 1003, Lausanne, Switzerland
| | - Piergiorgio Neri
- The Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.,Cleveland Lerner College of Medicine, Case Western University, Cleveland, OH, USA.,Khalifa University, Abu Dhabi, United Arab Emirates
| | | | - Carl P Herbort
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Rue Charles-Monnard 6, 1003, Lausanne, Switzerland.
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Yamashita Y, Saito M, Hirooka K, Ishida S. Laser speckle flowgraphy findings in focal scleral nodule. Graefes Arch Clin Exp Ophthalmol 2021; 260:697-700. [PMID: 34495368 PMCID: PMC8786776 DOI: 10.1007/s00417-021-05391-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/07/2021] [Accepted: 08/13/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Yui Yamashita
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Michiyuki Saito
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan.
| | - Kiriko Hirooka
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Susumu Ishida
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan
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Thompson IA, Caplash S, Akanda M, Sabbagh O, Choan B, Cheng SK, Okeagu C, Sen HN. Optical Coherence Tomography Angiography Changes in Choroidal Vasculature following Treatment in Punctate Inner Choroidopathy. Ocul Immunol Inflamm 2021; 29:944-950. [PMID: 32058825 DOI: 10.1080/09273948.2019.1705986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To describe the changes seen on optical coherence tomography angiography [OCTA] in patients with PIC following immunosuppressive therapy.Methods: We reviewed serial OCTA scans from five consecutive PIC patients (5 eyes) with at least 3 months of follow-up, who underwent imaging before and after immunosuppressive therapy. Using ImageJ, superficial and deep retinal vasculature were analyzed for vessel area and foveal avascular zone. Choriocapillaris layer was analyzed for flow signal loss.Results: Five out of five patients received an orbital floor triamcinolone acetonide injection as the initial treatment for periods of activity. Mean choriocapillaris (CC) flow void area obtained after immunosuppressive therapy was significantly lower than the mean CC flow void area obtained prior to treatment (Pre-treatment: 0.270 vs Post-treatment: 0.144; p = .0068). In 2 out of 2 patients with longitudinal visual field testing, CC flow voids were spatially associated with visual field defects, and immunosuppressive therapy was associated with reduced CC flow void area and improved visual function.Conclusion: OCTA can detect alterations in choriocapillaris flow. Longitudinal follow-up demonstrates a centripetal restoration of choriocapillaris flow in response to immunosuppressive therapy. OCTA may be a useful adjunct for monitoring and evaluating treatment of PIC.
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Affiliation(s)
- Ian Abban Thompson
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Sonny Caplash
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Marib Akanda
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Osama Sabbagh
- Department of Ophthalmology, George Washington University, Washington, District of Columbia, USA
| | - Ben Choan
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Shuk K Cheng
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Chinwenwa Okeagu
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Hatice Nida Sen
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
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Niederer R, Bar A, Al-Ani H, Sharief L, Sar S, Segal A, Lightman S, Tomkins-Netzer O. Management of inflammatory choroidal neovascular membranes. EXPERT REVIEW OF OPHTHALMOLOGY 2020. [DOI: 10.1080/17469899.2021.1842196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Rachael Niederer
- University of Auckland, Auckland District Health Board, Auckland, New Zealand
| | - Asaf Bar
- Department of Ophthalmology, Wolfson Medical Centre, Tel Aviv-Yafo, Israel
| | - Haya Al-Ani
- University of Auckland, Auckland District Health Board, Auckland, New Zealand
| | - Lazha Sharief
- UCL/Institute of Ophthalmology and Moorfileds Eye Hospital, London, UK
| | - Shaul Sar
- Department of Ophthalmology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Adi Segal
- Department of Ophthalmology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Sue Lightman
- UCL/Institute of Ophthalmology and Moorfileds Eye Hospital, London, UK
| | - Oren Tomkins-Netzer
- Department of Ophthalmology, Lady Davis Carmel Medical Center, Haifa, Israel
- Ruth and Bruch Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel
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Mizuuchi K, Saito W, Namba K, Ishida S. Multiple evanescent white dot syndrome and panuveitis: a case report. J Ophthalmic Inflamm Infect 2020; 10:26. [PMID: 33123841 PMCID: PMC7596130 DOI: 10.1186/s12348-020-00221-3] [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: 06/30/2020] [Accepted: 10/15/2020] [Indexed: 11/26/2022] Open
Abstract
Aim To report a patient with multiple evanescent white dot syndrome (MEWDS) complicated by iridocyclitis and vitritis. Case description A 70-year-old woman developed multiple subretinal white dots, iritis, and diffuse vitreous opacity. Angiographic and macular morphological features were consistent with those of MEWDS. Inflammatory findings including the white dots improved following only topical dexamethasone within 1 month after the initial visit. Best-corrected visual acuity recovered to 1.0 with restored photoreceptor structure. Conclusion The presence of iridocyclitis and vitritis, atypical to MEWDS, indicates the concurrent development of panuveitis associated with MEWDS. These results suggest that MEWDS is a clinical entity of uveitis.
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Zhang J, Zhang M, Ouyang W, Wang F, Li S. Characteristics of punctate inner choroidopathy complicated by choroidal neovascularisation on Multispectral Imaging in comparison with other imaging modalities. Ocul Immunol Inflamm 2020; 30:402-408. [PMID: 33215937 DOI: 10.1080/09273948.2020.1800751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To describe the characteristics seen on multispectral imaging (MSI) in patients with punctate inner choroidopathy (PIC) and choroidal neovascularisation (CNV) and compare the findings with current standard multimodal imaging techniques. METHODS This is a retrospective observational case series of 10 patients with PIC complicated by CNV that underwent multimodal retinal imaging examinations. RESULTS Twelve eyes of 10 patients were included. CNV was identified in 11 of the 12 eyes (91.7%) by MSI with nodular or trunk-like hyperreflectance on retinal oxy/deoxyhemoglobin map. MSI revealed choroidal vasculature around CNV in 91.7% eyes and pathological changes including retinal pigment epithelial atrophy and melanin disruption of punctate lesions in all eyes. CONCLUSION MSI helps in noninvasively detecting CNV in PIC patients and observing associated changes in choroidal vasculature. This imaging technique is also a promising tool for better tracking pathological changes of PIC lesions complementary to current standard multimodal imaging modalities.
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Affiliation(s)
- Jie Zhang
- Department of Ophthalmology, American-Sino Women's & Children's Hospital, Shanghai, China
| | - Minfang Zhang
- Department of Ophthalmology, Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
| | - Wangbin Ouyang
- Department of Ophthalmology, Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
| | - Fang Wang
- Department of Ophthalmology, Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
| | - Shiying Li
- Department of Ophthalmology, Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
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Gilbert RM, Niederer RL, Kramer M, Sharief L, Sharon Y, Bar A, Lightman S, Tomkins-Netzer O. Differentiating Multifocal Choroiditis and Punctate Inner Choroidopathy: A Cluster Analysis Approach. Am J Ophthalmol 2020; 213:244-251. [PMID: 32027868 DOI: 10.1016/j.ajo.2020.01.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 09/30/2019] [Accepted: 01/28/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE To develop a robust approach to clinical phenotyping of multifocal choroiditis (MFC) and punctate inner choroidopathy (PIC). DESIGN Cross-sectional and longitudinal observational study. METHODS This multicenter study included sites in the United Kingdom and Israel. The study population included 343 eyes of 185 subjects with hospital record diagnoses of MFC or PIC. Eyes were observed over a period of 5 years for clinically relevant characteristics, including demographics and multimodal imaging features, by observers masked to the original diagnoses. Multivariate 2-step cluster analysis was used to identify clusters of eyes in the database with similar clinical phenotypes, which were then analyzed for between-group differences. The primary outcome measure was the difference between clinical phenotype clusters identified using clinical criteria from the multivariate cluster analysis. RESULTS Subjects ranged from 11 to 89 years of age, with a baseline best-corrected visual acuity of 2.3 to -0.2 logarithm of minimal angle of resolution. Eighty-two percent of eyes were from females, 74% were myopic with a refractive error of +3.00 to -17.00 diopters (spherical equivalent). Cluster analysis prioritized clinical criteria of chorioretinal lesion location and intraocular inflammation and identified 2 distinct phenotype clusters resembling the original descriptions of MFC and PIC. During the 5-year period of observation, the initial clinical diagnosis remained stable for most eyes and only 1 eye (0.3%) changed diagnosis from PIC to MFC because of newly developed peripheral lesions. There were significant between-group differences in clinical characteristics, for example, in choroidal neovascular membrane development and treatment received. CONCLUSIONS Cluster analysis of this large cohort of eyes identified peripheral lesions and intraocular inflammation as distinct clinical phenotypes of MFC and PIC. The initial diagnosis remained stable for most eyes. This methodology could be useful for future uveitis classification and management.
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Affiliation(s)
- Rose M Gilbert
- Moorfields Eye Hospital National Health Service Foundation Trust, City Road, London, United Kingdom; University College London Institute of OphthalmologyBath Street, London, United Kingdom.
| | - Rachael L Niederer
- Moorfields Eye Hospital National Health Service Foundation Trust, City Road, London, United Kingdom; University College London Institute of OphthalmologyBath Street, London, United Kingdom; Greenlane Medical CentreAuckland District Health Board, Auckland, New Zealand
| | - Michal Kramer
- Rabin Medical Center, Petah Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lazha Sharief
- Moorfields Eye Hospital National Health Service Foundation Trust, City Road, London, United Kingdom; University College London Institute of OphthalmologyBath Street, London, United Kingdom
| | - Yael Sharon
- Rabin Medical Center, Petah Tikva, Israel; Metropolitan Eye Research and Surgery Institute, Palisades Park, New Jersey, USA
| | - Asaf Bar
- Moorfields Eye Hospital National Health Service Foundation Trust, City Road, London, United Kingdom; University College London Institute of OphthalmologyBath Street, London, United Kingdom; Wolfson Medical Centre, Holon, Tel Aviv-Yafo, Israel
| | - Sue Lightman
- Moorfields Eye Hospital National Health Service Foundation Trust, City Road, London, United Kingdom; University College London Institute of OphthalmologyBath Street, London, United Kingdom
| | - Oren Tomkins-Netzer
- Moorfields Eye Hospital National Health Service Foundation Trust, City Road, London, United Kingdom; University College London Institute of OphthalmologyBath Street, London, United Kingdom; Carmel Medical Center, Haifa, Israel
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Changes in choroidal blood flow velocity in patients diagnosed with central serous chorioretinopathy during follow-up for pachychoroid pigment epitheliopathy. Am J Ophthalmol Case Rep 2020; 18:100651. [PMID: 32215340 PMCID: PMC7090241 DOI: 10.1016/j.ajoc.2020.100651] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 12/23/2019] [Accepted: 03/03/2020] [Indexed: 11/21/2022] Open
Abstract
Purpose To evaluate chronological changes in choroidal blood flow velocity in two patients with pachychoroid pigment epitheliopathy (PPE) and central serous chorioretinopathy (CSC) in the same eye. Observations Two males aged 36 and 43 years old with PPE were diagnosed with CSC in the same eyes during follow-up. Using laser speckle flowgraphy, the macular mean blur rate (MBR), an index of relative blood flow velocity, was sequentially evaluated in the affected and unaffected eyes. In the affected eye, the macular MBR values at the onset of PPE and CSC were higher, at 25% and 33% in Case 1 and 21% and 51% in Case 2, respectively, than those on PPE regression; but the same trends were not observed in their fellow eyes. The increases in MBR changing rates were 1.3 and 2.5 times higher in Cases 1 and 2, respectively, at the onset of CSC than those at the onset of PPE. Conclusion and importance In the affected eyes, the rates of MBR change increased at the alternate onsets of PPE and CSC. The increased MBR changing rates were 1.3-2.5 times higher at the onset of CSC than those at the onset of PPE. Our data suggest that choroidal hyperperfusion is involved in the pathogenesis of both diseases and that its severity may differ between CSC and PPE. These results may support the hypothesis that PPE and CSC clinically overlap and have a common pathogenic background.
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Fukutsu K, Namba K, Iwata D, Mizuuchi K, Kase S, Suzuki K, Shimizu H, Shibata Y, Yamawaki F, Onozawa M, Ishida S. Pseudo-inflammatory manifestations of choroidal lymphoma resembling Vogt-Koyanagi-Harada disease: case report based on multimodal imaging. BMC Ophthalmol 2020; 20:94. [PMID: 32156266 PMCID: PMC7065374 DOI: 10.1186/s12886-020-01353-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 02/20/2020] [Indexed: 12/01/2022] Open
Abstract
Background Hematologic malignancies occasionally cause serous retinal detachment (SRD); however, its pathogenesis remains unclear. Here we present the imaging characteristics of metastatic choroidal lymphoma masquerading as Vogt-Koyanagi-Harada (VKH) disease. Case presentation A 45-year-old Japanese woman was referred to our clinic because of bilateral SRD with blurred vision. Fluorescein angiography revealed multiple pinpoint leakage followed by pooling OU. Enhanced depth imaging optical coherence tomography showed marked choroidal thickening OU. Laser speckle flowgraphy detected choroidal circulation impairment OU. Although these results totally agreed with the inflammatory manifestations of acute VKH disease, indocyanine green angiography demonstrated various sizes of sharply marginated hypofluorescent lesions that seemed atypical for the finding of VKH disease, i.e., vaguely marginated hypofluorescent small dots. Cerebrospinal fluid pleocytosis was not detected. Blood tests revealed leukocytosis together with elevation of lactate dehydrogenase and soluble interleukin-2 receptor levels. Corticosteroid pulse therapy did not improve any ocular findings. Bone marrow biopsy was then performed, leading to a definite diagnosis of diffuse large B-cell lymphoma. After starting systemic chemotherapy, both SRD and choroidal thickening resolved rapidly with visual recovery. However, choroidal hypoperfusion persisted, which contrasted distinctly with the inflammatory pattern of VKH disease, i.e., the restoration of choroidal blood flow in parallel with normalization of choroidal thickness. Conclusions Our detailed multimodal observations highlighted the differential imaging features of choroidal lymphoma despite close resemblance to VKH disease especially at the initial stage. Impaired circulation in the thickened choroid marked the pseudo-inflammatory pathogenesis of SRD due to choroidal involvement with neoplastic, but not inflammatory cells.
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Affiliation(s)
- Kanae Fukutsu
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Kenichi Namba
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan.
| | - Daiju Iwata
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Kazuomi Mizuuchi
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Satoru Kase
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Kayo Suzuki
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Hiroshi Shimizu
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Yukiko Shibata
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Fumihiko Yamawaki
- Department of Hematology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masahiro Onozawa
- Department of Hematology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Susumu Ishida
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan
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Hashimoto Y, Saito W, Saito M, Hasegawa Y, Ishida S. Increased thickness and decreased blood flow velocity of the choroid in a patient with acute macular neuroretinopathy. BMC Ophthalmol 2019; 19:109. [PMID: 31088423 PMCID: PMC6518730 DOI: 10.1186/s12886-019-1123-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 05/08/2019] [Indexed: 11/18/2022] Open
Abstract
Background The involvement of choroidal lesions in acute macular neuroretinopathy (AMN) is not yet fully understood. We quantitatively examined sequential changes in the morphology and circulation hemodynamics of the choroid using enhanced depth imaging optical coherence tomography (EDI-OCT) and laser speckle flowgraphy (LSFG) in a patient with AMN. Case presentation A 15-year-old boy was referred to our hospital due to AMN in his right eye alone. The next day AMN developed in his left eye. Three months later, AMN lesions in both eyes spontaneously resolved and the morphology of macular photoreceptors improved. Using EDI-OCT, central choroidal thickness (CCT) was examined for a period of three months, starting from the initial visit. Using LSFG, macular mean blur rate (MBR) was examined for three months, starting 1 week after the initial visit. At the first visit, CCT of the right eye with AMN was 82 μm higher than that of the left eye, which had not yet developed AMN, and decreased by 86 μm after three months. In the left eye, similarly, CCT increased by 16 μm after the AMN onset at 1 week compared with a pre-onset value at the first visit and thereafter decreased by 57 μm at 3 months. Macular MBR increased by 20–55% OD and 51–71% OS during the follow-up until 3 months. Conclusions We found that the choroid at the macula thickened at the onset of AMN and became thin with the regression of disease. Therefore, in concert with MBR data, these results further strengthened our hypothesis that choroidal circulation impairment plays a role in the pathogenesis of AMN.
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Affiliation(s)
- Yuki Hashimoto
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Nishi 7, Kita 15, Kita-ku, Sapporo, 060-8638, Japan
| | - Wataru Saito
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Nishi 7, Kita 15, Kita-ku, Sapporo, 060-8638, Japan. .,Kaimeido Eye and Dental Clinic, Sapporo, Japan.
| | - Michiyuki Saito
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Nishi 7, Kita 15, Kita-ku, Sapporo, 060-8638, Japan
| | - Yuka Hasegawa
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Nishi 7, Kita 15, Kita-ku, Sapporo, 060-8638, Japan
| | - Susumu Ishida
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Nishi 7, Kita 15, Kita-ku, Sapporo, 060-8638, Japan
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Lee JH, Lee SC, Park SJ, Lee CS. Punctate Inner Choroidopathy and Choroidal Neovascularization in Korean Patients. Ocul Immunol Inflamm 2018; 28:14-19. [DOI: 10.1080/09273948.2018.1489060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Ji Hwan Lee
- Department of Ophthalmology, The Institute of Vision Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Sung Chul Lee
- Department of Ophthalmology, The Institute of Vision Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Seo Jin Park
- Department of Ophthalmology, The Institute of Vision Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Christopher Seungkyu Lee
- Department of Ophthalmology, The Institute of Vision Research, Yonsei University College of Medicine, Seoul, South Korea
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Takita A, Hashimoto Y, Saito W, Kase S, Ishida S. Changes in blood flow velocity and thickness of the choroid in a patient with leukemic retinopathy. Am J Ophthalmol Case Rep 2018; 12:68-72. [PMID: 30259004 PMCID: PMC6151848 DOI: 10.1016/j.ajoc.2018.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 03/29/2018] [Accepted: 09/04/2018] [Indexed: 11/24/2022] Open
Abstract
Purpose Choroidal circulation hemodynamics in eyes with leukemia has not been quantitatively examined yet. We quantitatively examined changes in choroidal blood flow velocity and choroidal thickness at the macula by using laser speckle flowgraphy (LSFG) and enhanced depth imaging optical coherence tomography (EDI-OCT) in a patient with leukemic retinopathy. Observations A 15-year-old boy presented with sudden central vision loss of his right eye. The patient's best-corrected visual acuity was 0.09 OD and 1.2 OS. Funduscopy revealed a sub-inner limiting membrane hemorrhage at the macula, intra-retinal hemorrhages with Roth spots, and dilatation and tortuosity of retinal veins OU. Leukocytosis with the Philadelphia chromosome was found in the peripheral blood, which led to a diagnosis of retinopathy associated with chronic myeloid leukemia. Retinal hemorrhages resolved after chemotherapy. Macular mean blur rates on LSFG increased by 24–38% OD and 13–26% OS, while macular choroidal thicknesses on EDI-OCT decreased by 7–60 μm OD and 8–46 μm OS during the 3-month follow-up period after the start of treatment. Conclusion and importance These results suggest that choroidal blood flow velocity decreased and choroidal thickness increased sub-clinically in the acute stage of a patient with leukemic retinopathy. LSFG and EDI-OCT may be useful to non-invasively evaluate the activity of choroidal involvement in leukemic retinopathy.
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Affiliation(s)
- Akari Takita
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yuki Hashimoto
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Wataru Saito
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
- Kaimeido Eye and Dental Clinic, Sapporo, Japan
- Corresponding author. Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Nishi 7, Kita 15, Kita-ku, Sapporo, 060-8638, Japan.
| | - Satoru Kase
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Susumu Ishida
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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FOVEAL EXUDATE AND CHOROIDAL NEOVASCULARIZATION IN ATYPICAL CASES OF MULTIPLE EVANESCENT WHITE DOT SYNDROME. Retina 2018; 37:2025-2034. [PMID: 28098736 DOI: 10.1097/iae.0000000000001486] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe atypical cases of multiple evanescent white dot syndrome (MEWDS) associated with foveal exudation, increased choroidal thickness, and secondary Type 2 (subretinal) neovascularization. METHODS Four cases of atypical MEWDS were studied at a retina referral center. Patients underwent evaluation with multimodal retinal imaging, including fluorescein angiography, indocyanine green angiography, spectral-domain and enhanced depth imaging optical coherence tomography (OCT). Two patients were imaged with OCT angiography. RESULTS Four patients (3 female, 1 male) with a median age of 23.5 years presented with acute onset, painless, decreased central vision. All cases demonstrated fundus findings consistent with MEWDS on color photography, indocyanine green angiography, fluorescein angiography, fundus autofluorescence, and structural OCT imaging. On structural OCT, all 4 patients were noted to have hyperreflective subretinal material and increased subfoveal choroidal thickness ranging from 307 μm to 515 μm. Type 2 neovascularization was diagnosed in all four patients using fluorescein angiography, indocyanine green angiography, and/or OCT angiography. Two patients had poor visual acuity at the last follow-up despite resolution of characteristic clinical findings of MEWDS. CONCLUSION A subset of patients with atypical MEWDS may develop persistent poor vision due to subfoveal exudation and secondary Type 2 neovascularization. Patients showing increased choroidal thickness at presentation may be more susceptible to this unusual presentation.
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Kashani AH, Chen CL, Gahm JK, Zheng F, Richter GM, Rosenfeld PJ, Shi Y, Wang RK. Optical coherence tomography angiography: A comprehensive review of current methods and clinical applications. Prog Retin Eye Res 2017; 60:66-100. [PMID: 28760677 PMCID: PMC5600872 DOI: 10.1016/j.preteyeres.2017.07.002] [Citation(s) in RCA: 568] [Impact Index Per Article: 81.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 07/20/2017] [Accepted: 07/24/2017] [Indexed: 02/06/2023]
Abstract
OCT has revolutionized the practice of ophthalmology over the past 10-20 years. Advances in OCT technology have allowed for the creation of novel OCT-based methods. OCT-Angiography (OCTA) is one such method that has rapidly gained clinical acceptance since it was approved by the FDA in late 2016. OCTA images are based on the variable backscattering of light from the vascular and neurosensory tissue in the retina. Since the intensity and phase of backscattered light from retinal tissue varies based on the intrinsic movement of the tissue (e.g. red blood cells are moving, but neurosensory tissue is static), OCTA images are essentially motion-contrast images. This motion-contrast imaging provides reliable, high resolution, and non-invasive images of the retinal vasculature in an efficient manner. In many cases, these images are approaching histology level resolution. This unprecedented resolution coupled with the simple, fast and non-invasive imaging platform have allowed a host of basic and clinical research applications. OCTA demonstrates many important clinical findings including areas of macular telangiectasia, impaired perfusion, microaneurysms, capillary remodeling, some types of intraretinal fluid, and neovascularization among many others. More importantly, OCTA provides depth-resolved information that has never before been available. Correspondingly, OCTA has been used to evaluate a spectrum of retinal vascular diseases including diabetic retinopathy (DR), retinal venous occlusion (RVO), uveitis, retinal arterial occlusion, and age-related macular degeneration among others. In this review, we will discuss the methods used to create OCTA images, the practical applications of OCTA in light of invasive dye-imaging studies (e.g. fluorescein angiography) and review clinical studies demonstrating the utility of OCTA for research and clinical practice.
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Affiliation(s)
- Amir H Kashani
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of University of Southern California; Los Angeles, CA 90033, United States.
| | - Chieh-Li Chen
- Department of Biomedical Engineering, University of Washington Seattle, Seattle, WA 98195, United States
| | - Jin K Gahm
- Laboratory of Neuro Imaging (LONI), USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of University of Southern California, Los Angeles, CA 90033, United States
| | - Fang Zheng
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL 33136, United States
| | - Grace M Richter
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of University of Southern California; Los Angeles, CA 90033, United States
| | - Philip J Rosenfeld
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL 33136, United States
| | - Yonggang Shi
- Laboratory of Neuro Imaging (LONI), USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of University of Southern California, Los Angeles, CA 90033, United States
| | - Ruikang K Wang
- Department of Biomedical Engineering, University of Washington Seattle, Seattle, WA 98195, United States
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20
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Relationship between Choroidal Thickness and Visual Field Impairment in Acute Zonal Occult Outer Retinopathy. J Ophthalmol 2017; 2017:2371032. [PMID: 28758030 PMCID: PMC5516752 DOI: 10.1155/2017/2371032] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 05/29/2017] [Indexed: 11/17/2022] Open
Abstract
Purpose To evaluate sequential changes in choroidal thickness at the affected area in patients with acute zonal occult outer retinopathy (AZOOR). Methods This retrospective observational case series included 14 affected eyes and 6 unaffected fellow eyes from 10 AZOOR patients with impaired macular area. Using enhanced depth imaging optical coherence tomography, choroidal thicknesses at the subfovea and at nasal and temporal sites 1000 μm away from the fovea were manually measured at baseline and 3 and 6 months thereafter. Changes in the choroidal thicknesses and the average threshold at the affected area on Humphrey perimetry were compared during the 6-month follow-up. Results In AZOOR eyes, the average threshold at the affected area significantly increased over time, while outer retinal structure ameliorated. The mean choroidal thicknesses at all the sites measured significantly decreased at 3 and 6 months compared with baseline values in AZOOR eyes, but not in fellow eyes. There was an inverse correlation between the changing rates of the average threshold and the subfoveal choroidal thickness at 6 months from baseline. Conclusion The current data suggest that choroidal thickness at AZOOR-affected area significantly decreased with regression of AZOOR and this anatomical change correlated with the functional recovery.
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Effect of intravitreal ranibizumab on the ocular circulation of the untreated fellow eye. Graefes Arch Clin Exp Ophthalmol 2017; 255:1543-1550. [PMID: 28656342 PMCID: PMC5541094 DOI: 10.1007/s00417-017-3692-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/23/2017] [Accepted: 05/04/2017] [Indexed: 12/21/2022] Open
Abstract
Purpose To evaluate the effects of unilateral intravitreal ranibizumab (IVR) on the ocular circulation of the fellow eyes. Methods Fifteen eyes of 15 patients with macular edema (average age 69.6 ± 11.8 years) were studied. Eleven eyes had diabetic macular edema (DME) and four eyes had macular edema associated with a branch retinal vein occlusion. Each eye received 0.5 mg of IVR. The blood circulation on the optic nerve head of the treated and untreated eyes were determined by laser speckle flowgraphy (LSFG, Softcare Co., Ltd) before, 1 day, and 1 week after the IVR. The mean blur rate (MBR) and the relative changes of the MBRs determined as dMBR(%) = 100−(MBR before/MB after) × 100) were evaluated. The central macular thickness (CMT) and the rate of reduction in the thickness (dCMT = 100−(CMT before/CMT after) × 100) were also evaluated. Results The mean dMBR was significantly higher in the treated eyes than the untreated eyes at 1 day (−16.4 ± 17.0% vs 2.31 ± 19.3%) and at 1 week (−12.0 ± 14.6% vs 4.50 ± 25.9%) after the IVR (P = 0.02, paired t tests). Conclusion These findings indicate that if ranibizumab enters the systemic circulation, the concentration is not high enough to affect the ocular circulation of the fellow eyes.
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Ishikawa Y, Hashimoto Y, Saito W, Ando R, Ishida S. Blood flow velocity and thickness of the choroid in a patient with chorioretinopathy associated with ocular blunt trauma. BMC Ophthalmol 2017; 17:86. [PMID: 28595625 PMCID: PMC5465595 DOI: 10.1186/s12886-017-0480-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 05/28/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Choroidal circulation hemodynamics in eyes with ocular blunt trauma has not been quantitatively examined yet. We quantitatively examined changes in choroidal blood flow velocity and thickness at the lesion site using laser speckle flowgraphy (LSFG) and enhanced depth imaging optical coherence tomography (EDI-OCT) in a patient with chorioretinopathy associated with ocular blunt trauma. CASE PRESENTATION A 13-year-old boy developed a chorioretinal lesion with pigmentation extending from the optic disc to the superotemporal side in the right eye after ocular blunt trauma. The patient's best-corrected visual acuity (BCVA) was 0.2 in the right eye. Indocyanine green angiography showed hypofluorescence from the initial phase, with a decrease of mean blur rate (MBR) on LSFG color map, which corresponded to the chorioretinal lesion. The BCVA and foveal outer retinal morphologic abnormality spontaneously improved during follow-up. MBR and choroidal thickness increased by 23-31% and 13-17 μm at the lesion site and by 11-22% and 33-42 μm at the fovea, respectively, during the 6-month follow-up period after baseline measurements in the affected eye. In contrast, these parameters showed little or no changes at the normal retinal site in the affected eye and the fovea in the fellow eye. CONCLUSIONS Current data revealed that both blood flow velocity and thickness in the choroid at the lesion site decreased in the acute stage and subsequently increased together with improvements in visual function and outer retinal morphology. These results suggest that LSFG and EDI-OCT may be useful indices that can noninvasively evaluate activity of choroidal involvement in ocular blunt trauma-associated chorioretinopathy.
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Affiliation(s)
- Yuri Ishikawa
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Nishi 7, Kita 15, Kita-ku, Sapporo, 060-8638, Japan
| | - Yuki Hashimoto
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Nishi 7, Kita 15, Kita-ku, Sapporo, 060-8638, Japan
| | - Wataru Saito
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Nishi 7, Kita 15, Kita-ku, Sapporo, 060-8638, Japan. .,Kaimeido Eye and Dental Clinic, Sapporo, Japan.
| | - Ryo Ando
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Nishi 7, Kita 15, Kita-ku, Sapporo, 060-8638, Japan
| | - Susumu Ishida
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Nishi 7, Kita 15, Kita-ku, Sapporo, 060-8638, Japan
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Zhang X, Cole E, Pillar A, Lane M, Waheed N, Adhi M, Magder L, Quigley H, Saeedi O. The Effect of Change in Intraocular Pressure on Choroidal Structure in Glaucomatous Eyes. Invest Ophthalmol Vis Sci 2017; 58:3278-3285. [PMID: 28666278 PMCID: PMC5493330 DOI: 10.1167/iovs.17-21598] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 05/08/2017] [Indexed: 01/22/2023] Open
Abstract
Purpose Choroidal thickness increases linearly with intraocular pressure (IOP) lowering. We studied the relationship between the change in size of the choroidal vasculature and IOP lowering after glaucoma procedures. Methods Thirty eyes of twenty-nine patients were examined pre- and postoperatively for up to 6 months with standard clinical assessment, enhanced depth imaging spectral-domain optical coherence tomography (OCT), and axial length measurement. Each enhanced depth imaging spectral-domain OCT image was analyzed using three separate methods to determine the choroidal thickness, choroidal vessel thickness, choroidal interstitial thickness, large choroidal vessel layer thickness, medium choroidal vessel layer thickness, and light-dark ratio. Bivariate linear regression analysis was completed with largest change in IOP as the independent variable. The dependent variables included choroidal thickness, choroidal vessel thickness, and choroidal interstitial thickness, at the largest change in IOP. Multivariable regression analysis using a generalized estimating equation to account for multiple measurements per eye was also completed. Results Mean choroidal vessel thickness increases 1.5 μm for every 1 mm Hg decrease in IOP (P < 0.0001; 95% confidence interval [CI], 0.8, 2.1) and choroidal interstitial thickness increases 1.3 μm for every 1 mm Hg change in IOP (P < 0.0001; 95% CI, 0.8, 1.8). There was no significant association between change in IOP and change in large choroidal vessel layer temporally (P = 0.13), nasally (P = 0.20), or subfoveally (P = 0.18). There was also no association between IOP and the light-dark ratio (P = 0.16). Conclusions The increase in choroidal thickness at lower IOP is associated with approximately equal increases in its intravascular and extravascular compartments.
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Affiliation(s)
- Xuemin Zhang
- Medstar Harbor Hospital, Baltimore, Maryland, United States
| | - Emily Cole
- Tufts University School of Medicine, Boston, Massachusetts, United States
| | - Angelique Pillar
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Mark Lane
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Nadia Waheed
- New England Eye Center/Tufts University School of Medicine, Boston, Massachusetts, United States
| | - Mehreen Adhi
- Department of Ophthalmology and Visual Sciences, University of Louisville School of Medicine, Louisville, Kentucky, United States
| | - Laurence Magder
- University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Harry Quigley
- Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, United States
| | - Osamah Saeedi
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland, United States
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SINGLE ACQUISITION OF THE VITREOUS, RETINA AND CHOROID WITH SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY IN ACUTE TOXOPLASMOSIS. Retin Cases Brief Rep 2017; 10:217-20. [PMID: 26510002 DOI: 10.1097/icb.0000000000000230] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/PURPOSE To report the swept-source optical coherence tomography (SS-OCT) findings in a case of acute toxoplasmosis chorioretinitis. METHODS A 35-year-old male presented with acute blurry vision and floaters in his left eye. Ophthalmic examination, color photographs, spectral-domain OCT (SD-OCT), enhanced depth imaging OCT (EDI-OCT), SS-OCT and wide-field fluorescein angiography images were obtained to diagnose and follow the subsequent changes of toxoplasmosis chorioretinitis over a 2-month period. RESULTS Initial imaging with different modalities of SD- and EDI-OCT including radial vitreous scans and horizontal high-speed B-scan raster lines demonstrated thickening of the posterior hyaloid and acute vitreous cells emanating from the retinal blood vessels, thickening and disorganization of the retinal layers within the chorioretinal lesion, and increased sub-lesional choroidal thickness, respectively. SS-OCT demonstrated all of these same findings in a single 12-mm B-scan. Topical steroids were initiated and imaging over the next 2 months showed separation of the posterior hyaloid, decrease in vitreous cell, and atrophy of the chorioretinal lesion. CONCLUSION We report the first SS-OCT images of an acute case of toxoplasmosis chorioretinitis. SS-OCT can visualize the choroidal, retinal, and vitreous changes in a single scan, compared with the different imaging algorithms required with SD-OCT.
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25
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Hashimoto Y, Saito W, Saito M, Hasegawa Y, Mori S, Noda K, Ishida S. Relationship between choroidal thickness and visual impairment in multiple evanescent white dot syndrome. Acta Ophthalmol 2016; 94:e804-e806. [PMID: 26891597 DOI: 10.1111/aos.12992] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 12/24/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Yuki Hashimoto
- Department of Ophthalmology; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Wataru Saito
- Department of Ophthalmology; Hokkaido University Graduate School of Medicine; Sapporo Japan
- Department of Ocular Circulation and Metabolism; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Michiyuki Saito
- Department of Ophthalmology; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Yuka Hasegawa
- Department of Ophthalmology; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Shohei Mori
- Department of Ophthalmology; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Kousuke Noda
- Department of Ophthalmology; Hokkaido University Graduate School of Medicine; Sapporo Japan
- Department of Ocular Circulation and Metabolism; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Susumu Ishida
- Department of Ophthalmology; Hokkaido University Graduate School of Medicine; Sapporo Japan
- Department of Ocular Circulation and Metabolism; Hokkaido University Graduate School of Medicine; Sapporo Japan
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Takemoto Y, Namba K, Mizuuchi K, Iwata D, Uno T, Ohno S, Hirooka K, Hashimoto Y, Saito W, Sugiyama K, Ishida S. Choroidal circulation impairment during the anterior recurrence of Vogt-Koyanagi-Harada disease confirmed with indocyanine green angiography and laser speckle flowgraphy. Acta Ophthalmol 2016; 94:e629-e636. [PMID: 27079805 DOI: 10.1111/aos.13024] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 01/23/2016] [Indexed: 12/01/2022]
Abstract
PURPOSE To assess choroidal inflammation-related circulatory changes associated with the anterior recurrence of Vogt-Koyanagi-Harada (VKH) disease, using indocyanine green angiography (ICGA) and laser speckle flowgraphy (LSFG). METHODS This retrospective case series included 17 eyes of 11 patients with VKH disease showing recurrent inflammatory findings in the anterior, but not posterior, segment (i.e. anterior recurrence). Indocyanine green angiography (ICGA) and LSFG were performed at the time of recurrence and one month after the initiation of corticosteroid therapy. The number and total area of hypofluorescent dark dots (HDDs) on ICGA were independently counted by three physicians and measured with ImageJ, respectively. Mean blur rate (MBR), a quantitative index of relative blood flow velocity, was calculated via the LSFG Analyzer software. RESULTS Hypofluorescent dark dots (HDDs) were identified on ICGA in 13 of 17 eyes (76%) with the anterior recurrence of VKH disease. The number and total area of HDDs significantly decreased from 203 ± 101 dots to 59 ± 51 dots and from 48 789 ± 24 251 pixels to 15 664 ± 13 254 pixels, respectively. The change ratio of MBR significantly increased by 17.9 ± 16.3% after the treatment. Importantly, there was no significant association between the change ratios of HDDs and MBR. CONCLUSIONS These findings on LSFG and ICGA clearly demonstrated subclinical involvement as well as post-treatment improvement of choroidal circulation impairment due to granulomatous inflammation in eyes with the anterior recurrence of VKH disease. The present data suggest the validity of using these two examinations, capable of detecting different circulatory changes, in the management of recurrent VKH disease.
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Affiliation(s)
- Yuko Takemoto
- Department of Ophthalmology; Hokkaido University Graduate School of Medicine; Sapporo Japan
- Department of Ophthalmology and Visual Science; Kanazawa University Graduate School of Medicine; Kanazawa Japan
| | - Kenichi Namba
- Department of Ophthalmology; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Kazuomi Mizuuchi
- Department of Ophthalmology; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Daiju Iwata
- Department of Ophthalmology; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Tomoe Uno
- Department of Ophthalmology; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Shigeaki Ohno
- Department of Ophthalmology; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Kiriko Hirooka
- Department of Ophthalmology; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Yuki Hashimoto
- Department of Ophthalmology; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Wataru Saito
- Department of Ophthalmology; Hokkaido University Graduate School of Medicine; Sapporo Japan
- Department of Ocular Circulation and Metabolism; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Kazuhisa Sugiyama
- Department of Ophthalmology and Visual Science; Kanazawa University Graduate School of Medicine; Kanazawa Japan
| | - Susumu Ishida
- Department of Ophthalmology; Hokkaido University Graduate School of Medicine; Sapporo Japan
- Department of Ocular Circulation and Metabolism; Hokkaido University Graduate School of Medicine; Sapporo Japan
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Ahnood D, Madhusudhan S, Tsaloumas MD, Waheed NK, Keane PA, Denniston AK. Punctate inner choroidopathy: A review. Surv Ophthalmol 2016; 62:113-126. [PMID: 27751823 DOI: 10.1016/j.survophthal.2016.10.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 10/05/2016] [Accepted: 10/10/2016] [Indexed: 12/14/2022]
Abstract
Punctate inner choroidopathy (PIC), an idiopathic inflammatory multifocal chorioretinopathy that predominantly affects young myopic women, appears to be relatively rare, but there are limited data to support accurate estimates of prevalence, and it is likely that the condition is underdiagnosed. The etiological relationship between PIC and other conditions within the "white dot syndromes" group remains uncertain. We, like others, would suggest that PIC and multifocal choroiditis with panuveitis represent a single disease process that is modified by host factors (including host immunoregulation) to cause the range of clinical phenotypes seen. The impact of PIC on the patient is highly variable, with outcome ranging from complete spontaneous recovery to bilateral severe sight loss. Detection and monitoring have been greatly facilitated by modern scanning techniques, especially optical coherence tomography and autofluorescence imaging and may be enhanced by coregistration of sequential images to detect change over time. Depending on the course of disease and nature of complications, appropriate treatment may range from observation to systemic immunosuppression and antiangiogenic therapies. PIC is a challenging condition where treatment has to be tailored to the patient's individual circumstances, the extent of disease, and the risk of progression.
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Affiliation(s)
- Dana Ahnood
- Department of Ophthalmology, Royal Glamorgan Hospital, Cwm Taf University Health Board, Cardiff, United Kingdom
| | - Savitha Madhusudhan
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
| | - Marie D Tsaloumas
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Centre for Rare Diseases, Institute of Translational Medicine, Birmingham Health Partners, Birmingham, United Kingdom
| | - Nadia K Waheed
- New England Eye Center, Tufts Medical Center, Tufts University School of Medicine, Boston, USA
| | - Pearse A Keane
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Alastair K Denniston
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Centre for Rare Diseases, Institute of Translational Medicine, Birmingham Health Partners, Birmingham, United Kingdom; Academic Unit of Ophthalmology, Institute of Inflammation & Ageing, University of Birmingham, Birmingham, United Kingdom.
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Yu S, Lu J, Cao D, Liu R, Liu B, Li T, Luo Y, Lu L. The role of optical coherence tomography angiography in fundus vascular abnormalities. BMC Ophthalmol 2016; 16:107. [PMID: 27412442 PMCID: PMC4944429 DOI: 10.1186/s12886-016-0277-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 06/13/2016] [Indexed: 01/21/2023] Open
Abstract
Background To evaluate the role of optical coherence tomography angiography (OCTA) in observation of fundus vascular abnormalities. Methods Patients (n = 50, 10 in each group) with fundus disorders including branch retinal vein occlusion (BRVO), non-proliferative diabetic retinopathy (NPDR), proliferative diabetic retinopathy (PDR), exudative age-related macular degeneration (AMD), and polypoidal choroidal vasculopathy (PCV) were examined. They underwent imaging of OCTA and fluorescein angiography/indocyanine green angiography. The split-spectrum amplitude-decorrelation angiography algorithm was employed to obtain angiography within a 6 × 6 mm scanning area at the posterior retina. Segmentation algorithm was used to obtain 2-dimensional images from arbitrary layers. The OCTA features were analyzed and compared with the findings of conventional angiography. The contralateral eyes of the patients with BRVO and the eyes of 20 healthy volunteers served as controls. Results OCTA showed precise images of normal and abnormal vasculature in the posterior retina and choroid by the given layers. Vascular abnormalities such as enlarged foveal avascular zone (FAZ), non-perfusion area of retina, microaneurysm, retinal neovascularization, choroidal neovascularization (CNV), branching vascular network and polypoidal lesions in choroid were clearly displayed by OCTA. Conclusions OCTA provided a better projection of vascular pathologies of the posterior retina and choroid and could determine the precise location of the vascular lesion. The noninvasive OCTA can benefit the diagnosis of vascular abnormalities in the posterior retina and choroid.
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Affiliation(s)
- Shanshan Yu
- State Key Laboratory of Ophthalmology, Zhongshan Image Reading Center, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Jing Lu
- State Key Laboratory of Ophthalmology, Zhongshan Image Reading Center, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Di Cao
- State Key Laboratory of Ophthalmology, Zhongshan Image Reading Center, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Ruyuan Liu
- State Key Laboratory of Ophthalmology, Zhongshan Image Reading Center, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Bingqian Liu
- State Key Laboratory of Ophthalmology, Zhongshan Image Reading Center, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Tao Li
- State Key Laboratory of Ophthalmology, Zhongshan Image Reading Center, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Yan Luo
- State Key Laboratory of Ophthalmology, Zhongshan Image Reading Center, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Lin Lu
- State Key Laboratory of Ophthalmology, Zhongshan Image Reading Center, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China.
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Polascik BA, Grewal DS, Jiramongkolchai K, Fekrat S. Choroidal Thickness and En Face Optical Coherence Tomography Imaging in Autoimmune Retinopathy. Ophthalmic Surg Lasers Imaging Retina 2016; 47:362-5. [PMID: 27065377 DOI: 10.3928/23258160-20160324-10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 02/08/2016] [Indexed: 11/20/2022]
Abstract
A 57-year-old white woman developed autoimmune retinopathy (AIR) in both eyes associated with bilateral autoimmune sensorineural hearing loss. Laboratory testing was positive for 68kDa (heat-shock protein) and 136kDa (human interstitial retinoid-binding protein). Extensive cancer screening was negative. Spectral-domain optical coherence tomography enhanced depth imaging demonstrated a markedly thickened choroid in both eyes. En face imaging showed a distinctive pattern of granular hyperreflective foveal dots. The concurrent sensorineural hearing loss was thought to be of autoimmune origin and also responded to immunosuppressive treatment. Eyes with non-paraneoplastic, seropositive AIR may have associated increased choroidal thickness. Audiology testing should be considered.
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Hirooka K, Saito W, Saito M, Hashimoto Y, Mori S, Noda K, Ishida S. Increased choroidal blood flow velocity with regression of acute posterior multifocal placoid pigment epitheliopathy. Jpn J Ophthalmol 2016; 60:172-8. [PMID: 27020453 DOI: 10.1007/s10384-016-0440-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 01/25/2016] [Indexed: 01/30/2023]
Abstract
PURPOSE To quantitatively examine changes in choroidal circulation hemodynamics in patients with acute posterior multifocal placoid pigment epitheliopathy (APMPPE). METHODS Retrospective observational case series. Five eyes of 3 APMPPE patients were included. In all APMPPE eyes, laser speckle flowgraphy was conducted to evaluate the mean blur rate (MBR), a quantitative index of relative blood flow velocity. The changes in MBR at the initial visit and after 3 and 6 months were statistically analyzed. In 2 eyes, enhanced depth imaging optical coherence tomography was used to measure central choroidal thickness. RESULTS In all eyes, multiple subretinal placoid lesions spontaneously regressed with recovery of outer retinal morphology. The average MBR significantly increased at 3 and 6 months after baseline at the fovea by 49.6 and 54.2 % and at the lesion site by 65.2 and 70.8 %, respectively. These changes at both regions during the 6-month follow-up were statistically significant (P = 0.02 for each). The mean central choroidal thickness decreased with time (518.0 µm at baseline to 344.5 µm at 6 months). CONCLUSIONS Our data revealed the significant elevation of choroidal blood flow velocity and the substantial reduction of choroidal thickness with regression of APMPPE, suggesting that impaired choroidal circulation is involved in the pathogenesis of APMPPE.
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Affiliation(s)
- Kiriko Hirooka
- Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Wataru Saito
- Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
- Department of Ocular Circulation and Metabolism, Hokkaido University Graduate School of Medicine, Nishi 7, Kita 15, Kita-ku, Sapporo, 060-8638, Japan.
| | - Michiyuki Saito
- Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yuki Hashimoto
- Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Shohei Mori
- Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kousuke Noda
- Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
- Department of Ocular Circulation and Metabolism, Hokkaido University Graduate School of Medicine, Nishi 7, Kita 15, Kita-ku, Sapporo, 060-8638, Japan
| | - Susumu Ishida
- Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
- Department of Ocular Circulation and Metabolism, Hokkaido University Graduate School of Medicine, Nishi 7, Kita 15, Kita-ku, Sapporo, 060-8638, Japan
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Hashimoto Y, Saito W, Saito M, Hirooka K, Mori S, Noda K, Ishida S. Increased choroidal blood flow velocity with regression of unilateral acute idiopathic maculopathy. Jpn J Ophthalmol 2015; 59:252-60. [PMID: 25903315 DOI: 10.1007/s10384-015-0380-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 03/10/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE The pathogenesis of unilateral acute idiopathic maculopathy (UAIM) is unknown. The aim of this study was to quantitatively examine changes in choroidal circulation hemodynamics in patients with UAIM. METHODS This was a retrospective observational case-series which included five eyes of four patients with UAIM. All UAIM eyes and the fellow eyes in remaining three patients were studied using laser speckle flowgraphy (LSFG) to evaluate the mean blur rate (MBR), a quantitative index of relative blood flow velocity. The changes in MBR between the initial visit and after 1 and 3 months were statistically analyzed. Subfoveal choroidal thickness was measured in three UAIM eyes by enhanced depth imaging optical coherence tomography. RESULTS The mean logMAR value of best-corrected visual acuity in the UAIM eyes significantly improved (P = 0.04) with recovery of outer retinal morphology. The average MBR of the UAIM eyes significantly increased at 1 (+21.7% baseline value; P = 0.003) and 3 months (+32.5% baseline value; P = 0.001), whereas the fellow eyes did not show this tendency. The mean values of subfoveal choroidal thickness decreased with time (316.0 µm at baseline, 186.6 µm at 1 month, and 167.3 µm at 3 months). CONCLUSIONS These results reveal that there is a significant elevation of choroidal blood flow velocity and substantial reduction of choroidal thickness with regression of UAIM, suggesting that impaired choroidal circulation may be involved in the pathogenesis of UAIM.
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Affiliation(s)
- Yuki Hashimoto
- Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Relationship between choroidal blood flow velocity and choroidal thickness during systemic corticosteroid therapy for Vogt–Koyanagi–Harada disease. Graefes Arch Clin Exp Ophthalmol 2015; 253:609-17. [DOI: 10.1007/s00417-014-2927-5] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 12/28/2014] [Accepted: 12/30/2014] [Indexed: 11/25/2022] Open
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Hashimoto Y, Saito W, Saito M, Hirooka K, Mori S, Noda K, Ishida S. Decreased choroidal blood flow velocity in the pathogenesis of multiple evanescent white dot syndrome. Graefes Arch Clin Exp Ophthalmol 2014; 253:1457-64. [PMID: 25341956 DOI: 10.1007/s00417-014-2831-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 09/24/2014] [Accepted: 10/06/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE On the basis of angiographic features, it is suggested that choroidal circulation disturbance may be involved in the pathogenesis of multiple evanescent white dot syndrome (MEWDS). The aim of this study is to quantitatively evaluate changes in choroidal circulation hemodynamics using laser speckle flowgraphy (LSFG) in patients with MEWDS. METHODS Twelve eyes of 12 patients with MEWDS and 12 unaffected fellow eyes as controls were included. The macular mean blur rate (MBR), a quantitative index of relative blood flow velocity in the choroid, was measured by LSFG. Sequential changes in the average MBR values at the macula with granular changes and the lesion area with white dots were analysed. Moreover, correlations between the MRR changing rate and initial visual functions were examined. RESULTS Visual functions significantly improved 3 months after initial visit with accompanying improvements in outer retinal morphology. When compared with the baseline measurements, the MBR significantly increased at the macula of the affected eyes by 20.2 % and 13.0 % at 1 and 3 months respectively (P < 0.01 for both), while no significant change was detected in fellow eyes. Similarly, the MBR increased at the lesion area by 17.8 % and 12.0 % at 1 and 3 months respectively (P < 0.05 for both). Notably, the macular MBR elevation at 1 month was negatively correlated with both initial best-corrected visual acuity and the average threshold at the macula on Humphrey perimetry at baseline (R = -0.76, P = 0.003; R = -0.60, P = 0.03, respectively), suggesting a close link between initially reduced choroidal blood flow and functional abnormalities at the onset of MEWDS. CONCLUSIONS These results, in concert with angiographic findings, are likely to reinforce the concept of choroidal circulation impairment as a predisposing factor for MEWDS.
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Affiliation(s)
- Yuki Hashimoto
- Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Basic Technology and Clinical Applications of the Updated Model of Laser Speckle Flowgraphy to Ocular Diseases. PHOTONICS 2014. [DOI: 10.3390/photonics1030220] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Campos J, Campos A, Mendes S, Neves A, Beselga D, Sousa JPC. Punctate inner choroidopathy: a systematic review. MEDICAL HYPOTHESIS, DISCOVERY & INNOVATION OPHTHALMOLOGY JOURNAL 2014; 3:76-82. [PMID: 25741523 PMCID: PMC4348489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This article reviews clinically relevant data regarding punctate inner choroidopathy, mainly the various treatment options. Punctate inner choroidopathy is an uncommon, inflammatory, multifocal chorioretinopathy affecting mostly young myopic women. It is characterized by the presence of multiple, small, well-defined, yellow-white fundus lesions, in the absence of intraocular inflammation. We describe etiology, clinical findings and ancillary tests that help in the diagnosis and detection of complications. Treatment options that have been used to manage patients with PIC and CNV include immunosuppressants, corticoids, laser photocoagulation, photodynamic therapy, intravitreal anti-VEGF agents and submacular surgery.
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