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Yilmaz AC, Durukan AH. Evaluation of retina and choroid perfusion with optical coherence tomography angiography in patients with retinitis pigmentosa. Photodiagnosis Photodyn Ther 2023; 44:103755. [PMID: 37619949 DOI: 10.1016/j.pdpdt.2023.103755] [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: 05/25/2023] [Revised: 07/29/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE In this study, we aimed to evaluate macular perfusion with optical coherence tomography angiography (OCTA) and to investigate the correlation between OCTA quantitative data and visual acuity (VA) in patients with retinitis pigmentosa (RP). METHODS This retrospective single-center study was conducted on 60 eyes of 30 RP patients and 52 healthy eyes. The vessel density (VD) of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) of the macula, the size of foveal avascular zone (FAZ), choriocapillary flow density (FD) were measured using OCTA. Quantitative data obtained with OCTA were compared between the two groups. In addition, the correlation between the OCTA measurements and VA was examined. RESULTS In patients with RP, the choriocapillary FD was decreased (p = 0.001), the FAZ area was enlarged (p = 0.010), and the VDs of the SCP and DCP were decreased in all areas (p = 0.001). Correlation was found between VA and SCP VD, whole image (p = 0.011, rho = -0.327) and parafoveal (p = 0.001, rho = -0.444) areas. CONCLUSION Quantitative data from OCTA showed reduced macular perfusion in patients with RP compared to healthy controls. There was also a correlation between the quantitative OCTA data and VA.
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Affiliation(s)
- Alper Can Yilmaz
- Department of Ophthalmology, Merzifon State Hospital, Amasya, Turkey.
| | - Ali Hakan Durukan
- Gulhane School of Medicine, Department of Ophthalmology, University of Health Sciences, Ankara, Turkey
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Xu B, Wang S, Chen L, Tan J. The early diagnostic value of optical coherence tomography (OCT) and OCT angiography in thyroid-associated ophthalmopathy. Ther Adv Chronic Dis 2023; 14:20406223231166802. [PMID: 37187796 PMCID: PMC10176590 DOI: 10.1177/20406223231166802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 03/14/2023] [Indexed: 05/17/2023] Open
Abstract
Background The retinal microvascular density changes have been identified in thyroid-associated ophthalmopathy (TAO) patients. Whereas a lack of research has been done on the diagnostic ability of optical coherence tomography (OCT) combined with optical coherence tomography angiography (OCTA) parameters. Objectives This study aims to evaluate the retina perfusion variations in eyes with active and stable TAO and its diagnostic abilities using OCT and OCTA. Design This is cohort longitudinal retrospective study. Methods A total of 51 patients with TAO and 39 healthy controls (HCs) were recruited. The TAO eyes were divided into active and stable stage groups. The foveal avascular zone (FAZ), macular perfusion density (mPD), and peripapillary PD were measured by OCTA. The peripapillary retinal nerve fiber layer (RNFL), central retinal thickness (CRT), and whole macular volume (wMV) were measured by OCT. Visual evoked potential (VEP) and visual field (VF) were also assessed. Results The mPD of the superficial retinal capillary plexus (SRCP) was significantly different in all subfields among active, stable, and HC groups (p < 0.05) except for the temporal inner (p = 0.137), and the active group achieved the lowest PD. The FAZ size increased significantly in the active and stable groups compared with the HC group (p < 0.001). Significant difference was observed in mPD of deep retinal capillary plexus (DRCP) in all quadrants among three groups (p < 0.05). Moreover, PD parameters of optic nerve head (ONH) and radial peripapillary capillary plexus (RPCP) showed a different trend among three groups (p < 0.05). The r-value of visual field-mean deviation (VF-MD) of TAO with DRCP-whole PD (wPD) and RPCP-wPD was 0.421 and 0.299, respectively (p < 0.05). The DRCP-wPD in OCTA and RNFL in OCT were significantly higher in area under the receiver operating characteristic curve (AUC) than that of HC eyes. Conclusion OCT and OCTA can noninvasively detect the peripapillary and macular changes in various stages of TAO patients, and it might be a high diagnostic value tool to monitor the TAO progression.
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Affiliation(s)
- Bei Xu
- Eye Center of Xiangya Hospital, Central South
University, Changsha, China
- Hunan Key Laboratory of Ophthalmology, Central
South University, Changsha, China
- National Clinical Research Center for Geriatric
Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Sha Wang
- Eye Center of Xiangya Hospital, Central South
University, Changsha, China
- Hunan Key Laboratory of Ophthalmology, Central
South University, Changsha, China
- National Clinical Research Center for Geriatric
Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Lu Chen
- Eye Center of Xiangya Hospital, Central South
University, Changsha, China
- Hunan Key Laboratory of Ophthalmology, Central
South University, Changsha, China
- National Clinical Research Center for Geriatric
Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jia Tan
- Eye Center of Xiangya Hospital, Central South
University, Changsha, China
- Hunan Key Laboratory of Ophthalmology, Central
South University, Changsha, China
- National Clinical Research Center for
Geriatric Disorders, Xiangya Hospital, Central South University, Changsha,
China
- Department of Ophthalmology, Xiangya Hospital,
Central South University, No.87 Xiangya Road, Changsha 410008, China
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Bayat K, Hassanpour K, Sabbaghi H, Fekri S, Daftarian N, Motevasseli T, Suri F, Kheiri B, Yaseri M, Ahmadieh H. Choroidal structure investigated by choroidal vascularity index in patients with inherited retinal diseases. Int J Retina Vitreous 2023; 9:18. [PMID: 36978199 PMCID: PMC10044756 DOI: 10.1186/s40942-023-00457-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: 02/06/2023] [Accepted: 03/21/2023] [Indexed: 03/30/2023] Open
Abstract
PURPOSE To evaluate the choroidal structure in patients with inherited retinal diseases (IRDs) by investigating the choroidal vascularity index (CVI). METHODS The present study was conducted on 113 IRD patients and 113 sex- and age-matched healthy individuals. Patients' data was extracted from the Iranian National Registry for IRDs (IRDReg®). Total choroidal area (TCA) was determined between retinal pigment epithelium and choroid-scleral junction,1500 microns on either side of the fovea. Luminal area (LA) was considered as the black area corresponding to the choroidal vascular spaces, following Niblack binarization. CVI was calculated as the ratio of the LA to the TCA. CVI and other parameters were compared among different types of IRD and the control group. RESULTS The IRD diagnosis included retinitis pigmentosa (n = 69), cone-rod dystrophy (n = 15), Usher syndrome (n = 15), Leber congenital amaurosis (n = 9), and Stargardt disease (n = 5). Sixty-one (54.0%) individuals of each of the study and control groups were male. The average CVI was 0.65 ± 0.06 in the IRD patients and 0.70 ± 0.06 in the control group (P < 0.001). Accordingly, the average of TCA and LA were 2.32 ± 0.63 and 1.52 ± 0.44 mm [1] in patients with IRDs, respectively. The measurements for the TCA and the LA were significantly lower in all subtypes of IRD (P-values < 0.05). CONCLUSION CVI is significantly lower in patients with IRD than in healthy age-matched individuals. Choroidal changes in IRDs may be related to the changes in the lumen of the choroidal vessels rather than the stromal changes.
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Affiliation(s)
- Kia Bayat
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kiana Hassanpour
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamideh Sabbaghi
- Ophthalmic Epidemiology Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sahba Fekri
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Narsis Daftarian
- Ocular Tissue Engineering Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tahmineh Motevasseli
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Suri
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahareh Kheiri
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Ahmadieh
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Ripolles-Garcia A, Chen Y, Sato Y, Gray A, Ying GS, Aguirre GD, Beltran WA. Retinal Vascular Plexuses Are Unequally Affected in Canine Inherited Retinal Degenerations. Invest Ophthalmol Vis Sci 2022; 63:22. [PMID: 36378130 PMCID: PMC9672900 DOI: 10.1167/iovs.63.12.22] [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] [Indexed: 11/16/2022] Open
Abstract
Purpose To characterize the progression of vascular changes that occur in each retinal plexus, in three canine models of inherited retinal degeneration. Methods In this retrospective cohort study, we examined the retinal imaging records of 44 dogs from a research colony that had undergone optical coherence tomography angiography (OCTA) imaging. Animals enrolled included crd2/NPHP5 and xlpra2/RPGR mutant dogs imaged at different stages of photoreceptor loss, as well as RHOT4R/+ dogs after acute light-induced rod degeneration. Also included were normal controls imaged at similar ages. OCT angiograms of the superficial vascular plexus combined with the intermediate capillary plexus (SVP + ICP), and the deep capillary plexus (DCP) were analyzed using the AngioTool software to calculate vessel density and other vascular parameters. Results A reduction in vessel density was seen over time in both the SVP + ICP and DCP in all mutant dogs but was more pronounced in the DCP. Scans were subclassified based on outer nuclear layer (ONL) thinning compared to age-matched normal controls. When ONL loss was 0% to 50%, vessel density in the DCP was significantly lower than in age-matched controls. In all cases, when ONL loss exceeded 87.5%, vessel density in the SVP + ICP was significantly reduced as well. In the acute light-induced rod degeneration model, the vascular regression changes were observed mainly in the DCP. Conclusions Vessel density reduction in dogs undergoing retinal degeneration is first detected by OCTA in the DCP, and only at later stages in the SVP + ICP.
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Affiliation(s)
- Ana Ripolles-Garcia
- Division of Experimental Retinal Therapies, Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Yineng Chen
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Yu Sato
- Division of Experimental Retinal Therapies, Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Alexa Gray
- Division of Experimental Retinal Therapies, Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Gui-Shuang Ying
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Gustavo D. Aguirre
- Division of Experimental Retinal Therapies, Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - William A. Beltran
- Division of Experimental Retinal Therapies, Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
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Abdolalizadeh P, Kashkouli MB, Moradpasandi F, Falavarjani KG, Mirshahi R, Akbarian S. Optic Nerve Head Vessel Density Changes from Graves' Disease without TED to TED Dysthyroid Optic Neuropathy: Does Optic Nerve Head Ischemia Play a Role? Ophthalmic Plast Reconstr Surg 2022; 38:250-257. [PMID: 34593713 DOI: 10.1097/iop.0000000000002046] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To compare the retinal peripapillary capillary (RPC) vessel density (VD) between 5 groups of patients on the spectrum of thyroid eye disease (TED). METHOD This is a prospective comparative study looking at 5 groups of patients who were consecutively included from January 2018 to March 2021. They were composed of: Healthy volunteers (39 eyes and 20 subjects), patients with Graves' disease without TED (26 eyes and 13 patients), mild TED (28 eyes and 14 patients), moderate-severe TED (30 eyes and 17 patients), and TED with dysthyroid optic neuropathy (DON) (21 eyes and 12 patients). Ocular and periocular examination, visual field indices, RPC-VD (with optical coherence tomography angiography), and retinal nerve fiber layer, and macular ganglion cell complex thickness were recorded. RESULT An initial insignificant (0.5 < p < 0.9) rise in the peripapillary-VD (pp-VD) and whole image-VD (wi-VD) from the healthy subject to the Graves' disease without TED was followed by a significant (p = 0.001) fall in RPC-VD in different severity grades of the TED. Paired comparison between the 5 groups showed that the statistically significant fall from the Graves' disease group occurred in the moderate-severe and DON groups (0.001 ≤ p ≤ 0.04). No variable significantly affected the VD (0.08 ≤ p ≤ 0.9). A lower wi-VD and pp-VD were significantly (0.001 ≤ p ≤ 0.009) correlated with the impaired optic nerve functional and structural tests. The sensitivity and specificity of wi-VD (81% and 76%) and pp-VD (69% and 71%) for detecting the DON were statistically significant (p < 0.001). CONCLUSION Despite an insignificant rise in the wi- and pp-VD from the healthy volunteers to the patients with Graves' disease without TED, VD showed a declining trend in the course of patients with TED, which was statistically significant in the moderate-severe TED and DON groups.
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Affiliation(s)
- Parya Abdolalizadeh
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences
| | - Mohsen Bahmani Kashkouli
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences
| | - Farideh Moradpasandi
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences
| | - Khalil Ghasemi Falavarjani
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences
| | - Reza Mirshahi
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences
| | - Shadi Akbarian
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences
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Mateos-Olivares M, Sobas E, Puertas-Neyra K, Peralta-Ramírez M, Gonzalez-Pérez R, Martín-Vallejo J, García-Vazquez C, Coco R, Pastor J, Pastor-Idoate S, Usategui-Martín R. Hair cortisol level as a molecular biomarker in retinitis pigmentosa patients. Exp Eye Res 2022; 219:109019. [DOI: 10.1016/j.exer.2022.109019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/15/2022] [Accepted: 02/25/2022] [Indexed: 11/16/2022]
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Khaing TT, Okamoto T, Ye C, Mannan MA, Miura G, Yokouchi H, Nakano K, Aimmanee P, Makhanov SS, Haneishi H. Automatic measurement of choroidal thickness and vasculature in optical coherence tomography images of eyes with retinitis pigmentosa. ARTIFICIAL LIFE AND ROBOTICS 2022. [DOI: 10.1007/s10015-022-00737-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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8
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Outer Macular Microvascular Supply in Retinitis Pigmentosa Examined using Optical Coherence Tomography Angiography. J Ophthalmol 2022; 2021:5575851. [PMID: 34970452 PMCID: PMC8714321 DOI: 10.1155/2021/5575851] [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: 02/28/2021] [Revised: 11/09/2021] [Accepted: 11/26/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose To determine the vessel density of the superior (SCP) and deep retinal capillary plexuses (DCP) in patients with retinitis pigmentosa (RP) using optical coherence tomography angiography (OCTA). Methods This was a cross-sectional study. A total of 25 eyes of 25 healthy volunteers and 30 eyes of 17 patients with RP were evaluated in this study. The integrity of the ellipsoid zone in the macular fovea was evaluated as an intact or defect using a spectral-domain OCT. Commercial spectral domain coherence tomography angiography (OCTA) was used to scan the macular region of approximately 3 × 3 mm2. The vessel density in the SCP and DCP were calculated after appropriate layer segmentation and removal of projection artifacts. The central retinal thickness (CRT) was measured with automated software. The vessel densities in the SCP and DCP were compared between different groups using SPSS. Results A total of 25 eyes of 25 healthy subjects and 30 eyes of 17 patients with RP were evaluated in the study. There was no significant difference in ages between the two groups (F = 0.065 and P=0.937). There was a significant difference in SCP and DCP between the patients with RP and healthy individuals (P < 0.001 and P < 0.001). The DCP was significantly reduced in the parafovea region between the macular intact and defect groups (P < 0.05), except in the fovea and nasal regions. After linear regression, the DCP/SCP ratio in the whole, fovea, and parafovea regions was closely related to the DCP vessel density (P < 0.05), and CRT in the fovea and parafovea was not related to the whole DCP (P=0.186 and P=0.539). Conclusion The vessel density decreased in patients with RP, especially in the DCP of the parafovea region. A greater loss of capillaries in the DCP was found when the macular region was involved. The DCP/SCP ratio may be an important indicator of RP.
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Yilmaz AC, Durukan AH, Yilmaz H, Karaca U. Optical Coherence Tomography Angiography in Patients with Cone Dystrophy. Semin Ophthalmol 2021; 37:485-490. [PMID: 34586967 DOI: 10.1080/08820538.2021.1985527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE This study aimed to evaluate macular perfusion using optical coherence tomography angiography (OCTA) in patients with cone dystrophy and to determine the associations between the quantitative data of OCTA and functional parameters. METHODS The data of 36 eyes of 18 patients with cone dystrophy and 38 eyes of 19 healthy controls were analyzed. The superficial and deep capillary plexus (SCP and DCP) vessel densities (VD) of the macula, the foveal avascular zone (FAZ) and choriocapillary flow density values were obtained using OCTA. The associations between visual acuity (VA) and full-field electroretinography (ffERG) and the quantitative data of OCTA, and the associations between OCTA and ffERG were analyzed. RESULTS : VD was significantly lower in all areas except the foveal area in SCP in the cone dystrophy group compared to the control group. VA was found to be associated with the VDs of the SCP and DCP except for that of the foveal SCP. VA was also associated with dark-adapted, light-adapted wave amplitudes. CONCLUSION OCTA quantitatively showed that macular perfusion was decreased in cone dystrophy compared to the healthy controls. In addition, there was an association between VA and ffERG parameters and quantitative data of OCTA.
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Affiliation(s)
- Alper Can Yilmaz
- Department of Ophthalmology, Merzifon State Hospital, Amasya, Turkey
| | - Ali Hakan Durukan
- Department of Ophthalmology, Gulhane School of Medicine, University of Health Sciences, Ankara, Turkey
| | - Hayati Yilmaz
- Department of Ophthalmology, Hitit University, School of Medicine, Çorum, Turkey
| | - Umut Karaca
- School of Medicine, Department of Ophthalmology, Süleyman Demirel University, Isparta, Turkey
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Rahimi M, Leahy S, Matei N, Blair NP, Jeong S, Craft CM, Shahidi M. Assessment of inner retinal oxygen metrics and thickness in a mouse model of inherited retinal degeneration. Exp Eye Res 2021; 205:108480. [PMID: 33539865 DOI: 10.1016/j.exer.2021.108480] [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] [Received: 08/24/2020] [Revised: 01/15/2021] [Accepted: 01/26/2021] [Indexed: 12/20/2022]
Abstract
The retinal degeneration 1 (rd1) mouse is a well-established model of inherited retinal degeneration, displaying photoreceptor degeneration and retinal vasculature damage. The purpose of the current study was to determine alterations in the rate of oxygen delivery from retinal circulation (DO2), the rate of oxygen extraction from the retinal circulation for metabolism (MO2), and oxygen extraction fraction (OEF) in rd1 mice. The study was performed in a total of 18 wild type (WT) and 10 rd1 mice at both 3-weeks and 12-weeks of age. Retinal arterial and venous oxygen contents (O2A and O2V) were measured using phosphorescence lifetime imaging. Total retinal blood flow (TRBF) was determined by fluorescence and red-free imaging. DO2 and MO2 were determined as TRBF × O2A and TRBF × (O2A-O2V), respectively. OEF was calculated as MO2/DO2. The thickness of individual retinal layers was measured from histology sections and inner retina (IR) and total retina (TR) thickness were calculated. TRBF, DO2 and MO2 were lower in rd1 mice compared to WT mice (P ≤ 0.001), whereas OEF was not significantly different between rd1 and WT mice (P = 0.4). TRBF and DO2 were lower at 3-weeks of age compared to 12-weeks of age (P ≤ 0.01), while MO2 was not significantly different between age groups (P = 0.4) and OEF was higher at 3-weeks of age compared to 12-weeks of age (P = 0.003). Additionally, the outer and inner retinal cell layer thicknesses were decreased in rd1 mice at 12-weeks of age compared to both age-matched WT mice and rd1 mice at 3-weeks of age (P ≤ 0.02). MO2 was directly correlated with both IR and TR thickness (R ≥ 0.50; P ≤ 0.03, N = 20). The findings indicate that the rate oxygen is supplied by the retinal circulation is decreased and the reduction in oxygen extracted for metabolism is related to retinal cell layer thinning in rd1 mice.
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Affiliation(s)
- Mansour Rahimi
- Department of Ophthalmology, Keck School of Medicine of the University of Southern California, USC Roski Eye Institute, Los Angeles, CA, USA
| | - Sophie Leahy
- Department of Ophthalmology, Keck School of Medicine of the University of Southern California, USC Roski Eye Institute, Los Angeles, CA, USA
| | - Nathanael Matei
- Department of Ophthalmology, Keck School of Medicine of the University of Southern California, USC Roski Eye Institute, Los Angeles, CA, USA
| | - Norman P Blair
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Shinwu Jeong
- Department of Ophthalmology, Keck School of Medicine of the University of Southern California, USC Roski Eye Institute, Los Angeles, CA, USA
| | - Cheryl Mae Craft
- Department of Ophthalmology, Keck School of Medicine of the University of Southern California, USC Roski Eye Institute, Los Angeles, CA, USA; Department of Integrative Anatomical Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Mahnaz Shahidi
- Department of Ophthalmology, Keck School of Medicine of the University of Southern California, USC Roski Eye Institute, Los Angeles, CA, USA.
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The impact of macular edema on microvascular and metabolic alterations in retinitis pigmentosa. Graefes Arch Clin Exp Ophthalmol 2020; 259:643-652. [DOI: 10.1007/s00417-020-04913-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/15/2020] [Accepted: 08/25/2020] [Indexed: 10/23/2022] Open
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12
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Ivanova E, Corona C, Eleftheriou CG, Bianchimano P, Sagdullaev BT. Retina-specific targeting of pericytes reveals structural diversity and enables control of capillary blood flow. J Comp Neurol 2020; 529:1121-1134. [PMID: 32812219 DOI: 10.1002/cne.25011] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 12/14/2022]
Abstract
Pericytes are a unique class of mural cells essential for angiogenesis, maintenance of the vasculature and are key players in microvascular pathology. However, their diversity and specific roles are poorly understood, limiting our insight into vascular physiology and the ability to develop effective therapies. Here, in the mouse retina, a tractable model of the CNS, we evaluated distinct classes of mural cells along the vascular tree for both structural characterization and physiological manipulation of blood flow. To accomplish this, we first tested three inducible mural cell-specific mouse lines using a sensitive Ai14 reporter and tamoxifen application either by a systemic injection, or by local administration in the form of eye drops. The specificity and pattern of cre activation varied significantly across the three lines, under either the PDGFRβ or NG2 promoter (Pdgfrβ-CreRha, Pdgfrβ-CreCsln, and Cspg4-Cre). In particular, a mouse line with Cre under the NG2 promoter resulted in sparse TdTomato labeling of mural cells, allowing for an unambiguous characterization of anatomical features of individual sphincter cells and capillary pericytes. Furthermore, in one PDGFRβ line, we found that focal eye drop application of tamoxifen led to an exclusive Cre-activation in pericytes, without affecting arterial mural cells. We then used this approach to boost capillary blood flow by selective expression of Halorhodopsin, a highly precise hyperpolarizing optogenetic actuator. The ability to exclusively target capillary pericytes may prove a precise and potentially powerful tool to treat microcirculation deficits, a common pathology in numerous diseases.
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Affiliation(s)
- Elena Ivanova
- Burke Neurological Institute, White Plains, New York, USA.,Department of Ophthalmology, BMRI, Weill Cornell Medicine, New York, New York, USA
| | - Carlo Corona
- Burke Neurological Institute, White Plains, New York, USA
| | | | | | - Botir T Sagdullaev
- Burke Neurological Institute, White Plains, New York, USA.,Department of Ophthalmology, BMRI, Weill Cornell Medicine, New York, New York, USA
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Novel Insights into Beta 2 Adrenergic Receptor Function in the rd10 Model of Retinitis Pigmentosa. Cells 2020; 9:cells9092060. [PMID: 32917020 PMCID: PMC7563182 DOI: 10.3390/cells9092060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 08/31/2020] [Accepted: 09/08/2020] [Indexed: 12/18/2022] Open
Abstract
Background: In retinitis pigmentosa (RP), inherited rod death is followed by cone loss and blindness. Why cones die is still a matter of consideration. Here, we investigate the pathogenic role of the sympathetic transmission in the rd10 mouse model of RP. Methods: Retinal levels of beta adrenergic receptor (BAR) 2 and norepinephrine (NE) were measured. After administration of the BAR1/2 blocker propranolol or the hypoxia-inducible factor (HIF)-1 activator dimethyloxalylglycine (DMOG), retinal levels of HIF-1α, BAR2 or proteins involved in BAR2 desensitization were also measured. In DMOG treated mice, expression and localization of BAR2, inflammatory markers and cone arrestin were determined. Finally, rd10 mice were subjected to electroretinogram (ERG) analysis to assess rod and cone function. Results: In the rd10 retina, BAR2 overexpression and NE accumulation were found, with BAR2 immunoreactivity localized to Müller cells. BAR2 overexpression was likely due to desensitization defects. Upregulated levels of BAR2 were drastically reduced by propranolol that also restored desensitization defects. Due to the low level of HIF-1 consequent to the hyperoxic environment in the rd10 retina, we hypothesized a link between HIF-1 and BAR2. HIF-1α stabilization with DMOG resulted in i. increased HIF-1α accumulation, ii. decreased BAR2 levels, iii. restored desensitization processes, iv. reduced expression of inflammatory markers and v. increased cone survival without improved retinal function. Conclusions: Our results support a pathogenic role of the sympathetic system in RP that might help to understand why rd10 mice show a positive response to BAR blockers.
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Sabbaghi H, Ahmadieh H, Jalili J, Behnaz N, Fakhri M, Suri F, Kheiri B, Rajabpour M, Entezari M, Daftarian N. Choroidal Thickness in Different Types of Inherited Retinal Dystrophies. J Ophthalmic Vis Res 2020; 15:351-361. [PMID: 32864066 PMCID: PMC7431727 DOI: 10.18502/jovr.v15i3.7454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose To compare the choroidal thickness among eyes with retinitis pigmentosa (RP), Stargardt disease, Usher syndrome, cone-rod dystrophy, and healthy eyes of sex- and age-matched individuals. Methods In this comparative study, 503 eyes with RP (n = 264), cone-rod dystrophy (n = 109), Stargardt disease (n = 76), and Usher syndrome (n = 54) were included. To validate the data, 109 healthy eyes of 56 sex- and age-matched individuals were studied as controls. Choroidal imaging was performed using enhanced depth imaging-optical coherence tomography. Choroidal thickness was measured manually using MATLAB software at 13 points in nasal and temporal directions from the foveal center with the interval of 500 µm and the choroidal area encompassing the measured points was calculated automatically. Results The mean age was 36.33 ± 13.07 years (range, 5 to 72 years). The mean choroidal thickness at 13 points of the control eyes was statistically significantly higher than that in eyes with RP (P < 0.001) and Usher syndrome (P< 0.05), but not significantly different from that in eyes with Stargardt disease and cone-rod dystrophy. Among different inherited retinal dystrophies (IRDs), the choroidal thickness was the lowest in eyes with RP (P < 0.001). Choroidal thickness in the subfoveal area correlated negatively with best-corrected visual acuity (r = -0.264, P < 0.001) and the duration of ocular symptoms (r = -0.341, P < 0.001) in all studied IRDs. No significant correlation was observed between the subfoveal choroidal thickness and central macular thickness (r = -0.24, P = 0.576). Conclusion Choroidal thinning in four different types of IRDs does not follow a similar pattern and depends on the type of IRD and the duration of ocular symptoms. A larger cohort is required to verify these findings
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Affiliation(s)
- Hamideh Sabbaghi
- Ophthalmic Epidemiology Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Ahmadieh
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jalil Jalili
- Medical Physics and Biomedical Engineering Department, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazanin Behnaz
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Fakhri
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Suri
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahareh Kheiri
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mojtaba Rajabpour
- Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morteza Entezari
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Narsis Daftarian
- Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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AttaAllah HR, Mohamed AAM, Hamid MA. Quantification of Macular Microvascular Changes in Retinitis Pigmentosa Using Optical Coherence Tomography Angiography. Clin Ophthalmol 2020; 14:1705-1713. [PMID: 32606586 PMCID: PMC7319527 DOI: 10.2147/opth.s254909] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/02/2020] [Indexed: 01/30/2023] Open
Abstract
Purpose To investigate macular structural and microvascular changes in retinitis pigmentosa (RP) eyes compared to age-matched controls using spectral domain optical coherence tomography (SD-OCT) and OCT angiography (OCTA). Methods This was a cross-sectional study. The foveal and parafoveal thickness and extent of ellipsoid zone (EZ) disruption were measured on OCT. The foveal avascular zone (FAZ) area and retinal vessel density (VD) were automatically calculated for superficial (SCP) and deep capillary plexuses (DCP) and choriocapillaris using OCTA-integrated software. VD was assessed for the whole 6 × 6 mm image, foveal and parafoveal regions. Quantitative measures were compared between healthy and diseased eyes. Results The study included 30 eyes of 30 RP patients and 24 eyes of 24 controls. Mean age was 26.9±6.4 years for RP patients and 27.4±4.9 years for controls (p=0.76). Mean LogMAR visual acuity (VA) was 0.9±0.5 for RP patients and 0.05±0.05 for controls (p <0.001). Foveal and parafoveal thicknesses were significantly lower in RP cases as compared to the control group. EZ disruption was observed in RP cases only (869±211 µm). Mean FAZ area was significantly larger in RP eyes in both SCP and DCP. VD was significantly reduced in RP eyes at the level of SCP, DCP and choriocapillaris. VA, deep parafoveal VD, foveal, parafoveal and whole image choriocapillaris VD were negatively correlated with the extent of EZ disruption. Conclusion We report OCTA findings in a relatively young cohort of RP patients. We demonstrated a reduction of retinal microvascular density in all studied layers on OCTA. We believe studying retinal vasculature in these patients is important, as a healthy blood supply is a prerequisite for the success of new cell-based therapies under trial for RP.
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Affiliation(s)
- Heba Radi AttaAllah
- Department of Ophthalmology, Faculty of Medicine, Minia University, Minia, Egypt
| | | | - Mohamed A Hamid
- Department of Ophthalmology, Faculty of Medicine, Minia University, Minia, Egypt
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Abstract
PURPOSE To evaluate the correlation between the flow density measured by optical coherence tomography angiography and functional parameters in patients with retinitis pigmentosa. METHODS Twenty eyes of 20 patients with retinitis pigmentosa and 21 eyes of 21 healthy subjects were prospectively included in this study. Optical coherence tomography angiography was performed using RTVue XR Avanti with AngioVue (Optovue Inc). The macula was imaged with a 6 × 6-mm scan, whereas for the optic nerve head a 4.5 × 4.5-mm scan was taken. Visual acuity, visual field parameters (mean deviation and visual field index), full-field electroretinography, and multifocal electroretinography were tested for correlation with flow density data. RESULTS The flow density (whole en face) in the superficial/deep retinal OCT angiograms and in the optical coherence tomography angiography of the optic nerve head was significantly lower in the retinitis pigmentosa group when compared with the control group (P < 0.001). The flow density in the superficial retinal OCT angiogram (fovea) correlated significantly with the visual acuity (rSpearman = -0.77, P < 0.001) and the visual field parameters (visual field index: rSpearman = 0.56, P = 0.01; mean deviation: rSpearman = 0.54, P = 0.01). CONCLUSION Patients with retinitis pigmentosa show a decreased macular and optic nerve head perfusion compared with healthy subjects. The flow density measured using optical coherence tomography angiography correlated with subjective and objective functional parameters.
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Optical Coherence Tomography Angiography Assessed Retinal and Choroidal Microvasculature Features in Patients with Retinitis Pigmentosa: A Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2019; 2019:6723917. [PMID: 31828118 PMCID: PMC6881583 DOI: 10.1155/2019/6723917] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 09/24/2019] [Indexed: 12/20/2022]
Abstract
Background The aim of this study was to assess the retinal and choroidal microvasculature features using optical coherence tomography angiography (OCTA) in patients with retinitis pigmentosa (RP). Methods This study was a meta-analysis of relevant published studies that were included after a comprehensive search of PubMed, Embase, Cochrane Library, and Web of Science databases. Mean difference (MD) with a 95% confidence interval was used to assess continuous variable outcomes. Heterogeneity was evaluated using the chi-squared test based on the values of P and I2. Results Seven studies were included in this meta-analysis. The vessel density values measured in the superficial and deep foveal zones of RP patients using OCTA were significantly lower than the recorded values in the control groups (MD = −3.58, P=0.04; MD = −4.93, P=0.02, respectively). The superficial and deep parafoveal vessel density values measured with OCTA were also significantly lower in RP patients than in control groups (MD = −9.09, P < 0.00001; MD = −10.74, P < 0.00001, respectively); for choriocapillaris vessel density, there was no statistically significant difference between RP patients and controls (MD = −1.33, P=0.09). The deep foveal avascular zone (FAZ) was significantly larger in RP patients than in controls (MD = 0.15, P=0.01), whereas there was no significant difference in the superficial foveal avascular zones in the two groups (MD = 0.08, P=0.11). Conclusions We showed that retinal and choroidal vessels were attenuated in RP patients. Additionally, we revealed that the FAZ was larger in RP patients, especially the deep FAZ. OCTA may become a useful modality in the diagnosis and monitoring of patients with RP.
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della Volpe-Waizel M, Zuche HC, Müller U, Rickmann A, Scholl HPN, Todorova MG. Metabolic monitoring of transcorneal electrical stimulation in retinitis pigmentosa. Graefes Arch Clin Exp Ophthalmol 2019; 258:79-87. [DOI: 10.1007/s00417-019-04522-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 10/15/2019] [Accepted: 10/22/2019] [Indexed: 10/25/2022] Open
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Lang M, Harris A, Ciulla TA, Siesky B, Patel P, Belamkar A, Mathew S, Verticchio Vercellin AC. Vascular dysfunction in retinitis pigmentosa. Acta Ophthalmol 2019; 97:660-664. [PMID: 31099494 DOI: 10.1111/aos.14138] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 04/22/2019] [Indexed: 01/15/2023]
Abstract
The relationship between ocular haemodynamics and retinitis pigmentosa (RP) has not been fully understood. Reductions in blood flow have been established in RP patients by a variety of studies; however, questions have yet to be answered regarding the role of vascular dysfunction in photoreceptors (PR) degeneration, the causes of vascular dysfunction in RP, as well as the diagnostic, prognostic and perhaps therapeutic potential of measuring ocular haemodynamics in RP patients. While significant evidence supports the theory that vascular dysfunction is associated with but not the cause of PR death in retinitis pigmentosa, evidence suggests that vascular abnormalities in the foveal and parafoveal regions may exacerbate cone cell loss. Additional evidence demonstrates that vascular dysfunction likely results from changes in metabolic demand due to death of PR cells in the retina. Detection and monitoring of ocular blood flow, retinal oxygen saturation, endothelin-1 levels and vascular structural abnormalities could provide diagnostic, prognostic and therapeutic potential for patients with RP.
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Affiliation(s)
- Matt Lang
- Eugene and Marilyn Glick Eye Institute Department of Ophthalmology Indiana University School of Medicine Indianapolis Indiana
| | - Alon Harris
- Eugene and Marilyn Glick Eye Institute Department of Ophthalmology Indiana University School of Medicine Indianapolis Indiana
| | | | - Brent Siesky
- Eugene and Marilyn Glick Eye Institute Department of Ophthalmology Indiana University School of Medicine Indianapolis Indiana
| | - Pooja Patel
- Eugene and Marilyn Glick Eye Institute Department of Ophthalmology Indiana University School of Medicine Indianapolis Indiana
| | - Aditya Belamkar
- Eugene and Marilyn Glick Eye Institute Department of Ophthalmology Indiana University School of Medicine Indianapolis Indiana
| | - Sunu Mathew
- Eugene and Marilyn Glick Eye Institute Department of Ophthalmology Indiana University School of Medicine Indianapolis Indiana
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Wang X, Zhao Q, Li D, Wang Z, Chen W, Li Y, Cui R, Shen L, Wang RK, Peng X, Yang W. Quantitative evaluation of primary retinitis pigmentosa patients using colour Doppler flow imaging and optical coherence tomography angiography. Acta Ophthalmol 2019; 97:e993-e997. [PMID: 30963731 DOI: 10.1111/aos.14047] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 01/12/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE To find the potential relation between changes in retinal large vessels and terminal vessels using colour Doppler flow imaging (CDFI) and optical coherence tomography angiography (OCTA) and to compare the respective advantages of CDFI and OCTA in evaluating vascular changes in retinitis pigmentosa (RP) patients. METHODS A prospective series of case study was conducted to enrol RP patients and age-matched controls, who were, respectively, imaged by CDFI and OCTA. Repeatability and reproducibility of both CDFI and OCTA were performed among healthy volunteers. The central retinal artery (CRA) was detected by CDFI analysis to provide parameters of peak systolic velocity (PSV), end-diastolic velocity (EDV) and time-averaged maximum velocity (TAMV). Retinal parameters were evaluated from OCTA images, including vascular area density (VAD) of the superficial vascular layer, the fovea avascular zone (FAZ) area and retinal thickness. RP patients were separated into a high-vision group and a low-vision group, according to median vision (0.3, LogMAR 0.5). Multiple comparisons were used to analyse the data between groups. A correlation analysis was used to determine the correlation between CDFI and OCTA parameters. RESULTS Twenty RP patients (40 eyes) and thirteen normal volunteers (26 eyes) were enrolled in this study. Repeatability and reproducibility of the measurements by CDFI had higher CVs, from 4.5% to 15.4%, than those measurements by OCTA (<5%). All the CDFI and OCTA parameters examined had significant reductions in RP patients compared to those in the controls (p < 0.01). Compared to the high-vision group, the low-vision group exhibited a statistically significant decrease in vascular parameters of the FAZ area, fovea VAD and parafovea nasal side VAD (p < 0.05); as well as in the parameters of the fovea thickness, and the parafovea nasal, superior and inferior side thickness (p < 0.05). From the correlation analysis, a significant association was found between the vision and CDFI parameters (PSV and time-averaged maximum velocity (TAMX), p < 0.05), and the vision and OCTA parameters (FAZ area, fovea and nasal side VAD, retinal thickness in all sides, p < 0.05). PSV and TAMX of the CRA were closely related to the OCTA superficial VAD in all sides, whereas the CDFI parameters showed poor correlation with retinal thickness. CONCLUSIONS Colour Doppler flow imaging (CDFI) and OCTA parameters revealed a significant reduction in RP patients when compared to the controls. OCTA can detect vision-related microvascular and thickness changes around the macula between high- and low-vision groups, which happen earlier than the changes in large vessels. In addition to good repeatability and reproducibility, OCTA may have significant utility in the diagnosis and monitoring of disease progression in RP patients.
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Affiliation(s)
- Xiao‐Na Wang
- Department of ophthalmology Beijing Key Laboratory of Restoration of Damage Ocular Nerve Peking University Third Hospital Beijing China
| | - Qi Zhao
- Department of Ophthalmology Beijing Tongren Eye Center Beijing Tongren Hospital Capital Medical University Beijing Key Laboratory of Ophthalmology and Visual Sciences Beijing China
| | - Dong‐Jun Li
- Department of Ophthalmology Beijing Tongren Eye Center Beijing Tongren Hospital Capital Medical University Beijing Key Laboratory of Ophthalmology and Visual Sciences Beijing China
| | - Zi‐Yang Wang
- Department of Ophthalmology Beijing Tongren Eye Center Beijing Tongren Hospital Capital Medical University Beijing Key Laboratory of Ophthalmology and Visual Sciences Beijing China
| | - Wei Chen
- Department of Ophthalmology Beijing Tongren Eye Center Beijing Tongren Hospital Capital Medical University Beijing Key Laboratory of Ophthalmology and Visual Sciences Beijing China
| | - Yi‐Feng Li
- Department of Ophthalmology Beijing Tongren Eye Center Beijing Tongren Hospital Capital Medical University Beijing Key Laboratory of Ophthalmology and Visual Sciences Beijing China
| | - Rui Cui
- Department of Ophthalmology Beijing Tongren Eye Center Beijing Tongren Hospital Capital Medical University Beijing Key Laboratory of Ophthalmology and Visual Sciences Beijing China
| | - Lin Shen
- Department of Ophthalmology Beijing Tongren Eye Center Beijing Tongren Hospital Capital Medical University Beijing Key Laboratory of Ophthalmology and Visual Sciences Beijing China
| | - Ruikang K. Wang
- Beijing Institute of Ophthalmology Beijing Tongren Eye Center Beijing Tongren Hospital Capital Medical University Beijing China
- Department of Bioengineering University of Washington Seattle United States
| | - Xiao‐Yan Peng
- Beijing Institute of Ophthalmology Beijing Tongren Eye Center Beijing Tongren Hospital Capital Medical University Beijing China
| | - Wen‐Li Yang
- Department of Ophthalmology Beijing Tongren Eye Center Beijing Tongren Hospital Capital Medical University Beijing Key Laboratory of Ophthalmology and Visual Sciences Beijing China
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Freitag S, Hunold A, Klemm M, Klee S, Link D, Nagel E, Haueisen J. Pulsed Electrical Stimulation of the Human Eye Enhances Retinal Vessel Reaction to Flickering Light. Front Hum Neurosci 2019; 13:371. [PMID: 31695600 PMCID: PMC6817672 DOI: 10.3389/fnhum.2019.00371] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 09/30/2019] [Indexed: 12/11/2022] Open
Abstract
Recent studies indicate therapeutic benefits of electrical stimulation in cases of specific ophthalmic diseases that are associated with dysfunctional ocular microcirculation. This suggests effects of electrical stimulation on vascular functions. In the present study, we investigated the effects of electrical stimulation on retinal vessel reactions using dynamic vessel analysis (DVA). Eighty healthy subjects were randomly assigned to one of three groups receiving electrical stimulation with different current intensities: 400 μA (n = 26); 800 μA (n = 27); 1200 μA (n = 27). The electrode montage for electrical stimulation consisted of a ring-shaped active electrode surrounding one eye and a square return electrode at the occiput. Rectangular, monophasic, positive current pulses were applied at 10 Hz for a duration of 60 s per stimulation period. DVA was used to observe the stimulation-induced reactions of retinal vessel diameters in response to different provocations. In three DVA measurements, three stimulus conditions were investigated: flicker light stimulation (FLS); electrical stimulation (ES); simultaneous electrical and flicker light stimulation (ES+FLS). Retinal vasodilation caused by these stimuli was compared using paired t-test. The subjects receiving electrical stimulation with 800 μA showed significantly increased retinal vasodilation for ES+FLS compared to FLS (p < 0.05). No significant differences in retinal vessel reactions were found between ES+FLS and FLS in the 400 and 1200 μA groups. No retinal vasodilation was observed for ES for all investigated current intensities. The results indicate that positive pulsed electrical stimulation of an adequate intensity enhances the flicker light-induced retinal vasodilation.
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Affiliation(s)
- Stefanie Freitag
- Institute for Biomedical Engineering and Informatics, Technische Universität Ilmenau, Ilmenau, Germany
| | - Alexander Hunold
- Institute for Biomedical Engineering and Informatics, Technische Universität Ilmenau, Ilmenau, Germany
| | - Matthias Klemm
- Institute for Biomedical Engineering and Informatics, Technische Universität Ilmenau, Ilmenau, Germany
| | - Sascha Klee
- Institute for Biomedical Engineering and Informatics, Technische Universität Ilmenau, Ilmenau, Germany
| | - Dietmar Link
- Institute for Biomedical Engineering and Informatics, Technische Universität Ilmenau, Ilmenau, Germany
| | - Edgar Nagel
- Institute for Biomedical Engineering and Informatics, Technische Universität Ilmenau, Ilmenau, Germany.,Ophthalmic Private Practice, Rudolstadt, Germany
| | - Jens Haueisen
- Institute for Biomedical Engineering and Informatics, Technische Universität Ilmenau, Ilmenau, Germany
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Hagag AM, Wang J, Lu K, Harman G, Weleber RG, Huang D, Yang P, Pennesi ME, Jia Y. Projection-Resolved Optical Coherence Tomographic Angiography of Retinal Plexuses in Retinitis Pigmentosa. Am J Ophthalmol 2019; 204:70-79. [PMID: 30849344 DOI: 10.1016/j.ajo.2019.02.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE To use projection-resolved optical coherence tomographic angiography (PR-OCTA) to characterize the microvascular changes in 3 distinct retinal plexuses in retinitis pigmentosa (RP) patients. DESIGN Prospective cross-sectional study. METHODS A commercial 70-kHz spectral-domain optical coherence tomography (OCT) system was used to acquire 6-mm macular scans from RP patients and age-matched healthy participants at a tertiary academic center. Blood flow was detected using a commercial version of split-spectrum amplitude-decorrelation angiography (SSADA) algorithm. The PR-OCTA algorithm was used to suppress projection artifacts and resolve microvasculature in 3 plexuses around the macula. Vessel density was calculated from en face OCTA of the parafoveal and perifoveal regions in each of the 3 plexuses, as well as the all-plexus inner retinal slab. Inner and outer retinal thicknesses were measured form structural OCT scans. Generalized estimating equations and Spearman's rank correlation statistical methods were used. RESULTS Forty-four eyes from 26 RP patients and 34 eyes from 26 healthy subjects were included. Significant reduction in vessel density was detected in the perifovea but not the parafovea of inner retinal slab of RP patients (P = .001 and P = .56, respectively) compared to controls. We also found deeper retinal plexuses (intermediate and deep capillary plexuses, ICP and DCP) were primarily damaged by RP, compared to superficial vascular complex (SVC). Significant thickening of the inner retina and thinning of the outer retina were also observed. Strong correlation was found between the vessel density in the perifoveal ICP and DCP and outer retinal thickness in RP patients with no history of cystoid macular edema. CONCLUSIONS PR-OCTA enables the detection of microvascular changes in the perifoveal regions of the ICP and DCP in RP, with relative sparing of the SVC. OCT and OCTA parameters might be able to provide better understanding of the pathophysiology of the disease, as well as monitoring disease progression and the response to experimental treatments.
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Terelak-Borys B, Grabska-Liberek I, Schoetzau A, Konieczka K. Transient visual field impairment after cold provocation in glaucoma patients with Flammer syndrome. Restor Neurol Neurosci 2019; 37:31-39. [PMID: 30741709 PMCID: PMC6484275 DOI: 10.3233/rnn-180866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: It is still debatable whether visual field defects in glaucoma have a reversible component and to what extent a temporary loss can be provoked. Objective: To investigate the response of the visual function to a cold provocation in glaucoma patients, particularly to test whether subjects with Flammer syndrome (FS) behaved differently from subjects without FS. Methods: Ten (10) primary open-angle glaucoma (POAG) patients with FS, 7 POAG patients without FS, and 11 healthy controls were tested with program G2 on the Octopus 101 perimeter before and after putting one hand in cold water (4°C) for 2 min. The mean sensitivity (MS) of each visual field was included in the statistical analysis. Results: In glaucoma patients with FS, the mean MS significantly decreased after cold provocation (delta MS = –0.91 dB, CI = –1.43 to –0.39, p = 0.0014). In contrast, the mean MS in glaucoma patients without FS did not change significantly (delta MS = 0.17 dB, CI = –0.43 to 0.78, p = 0.56). Likewise, the mean MS did not change significantly in the healthy controls (delta MS = 0.23 dB, CI = –0.27 to 0.72, p = 0.36). Conclusions: Cold provocation induced a transient visual field deterioration in the glaucoma patients with FS but not in the glaucoma patients without FS or in the healthy controls. We assume this effect to be the result of a transient reduction of ocular blood flow.
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Affiliation(s)
- Barbara Terelak-Borys
- Department of Ophthalmology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Iwona Grabska-Liberek
- Department of Ophthalmology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Andreas Schoetzau
- Department of Ophthalmology, University of Basel, Basel, Switzerland
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Wei X, Mishra C, Kannan NB, Holder GE, Khandelwal N, Kim R, Agrawal R. Choroidal structural analysis and vascularity index in retinal dystrophies. Acta Ophthalmol 2019; 97:e116-e121. [PMID: 30178525 DOI: 10.1111/aos.13836] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 05/06/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE To assess choroidal structural changes in patients with retinal dystrophies using choroidal vascularity index (CVI), a novel optical coherence tomography (OCT) based tool. METHODS This retrospective study included 26 patients with retinal dystrophies (17 with retinitis pigmentosa, four with Stargardt disease, three with cone-rod dystrophy, one each with Best disease and Bietti crystalline dystrophy) and 32 healthy controls. Subfoveal OCT images were used for analysis. Mean CVI was compared between retinal dystrophy and control group, as well as among the retinal dystrophy subgroups. RESULTS Mean CVI in eyes with retinal dystrophies was 52 ± 9% and it was significantly lower compared to that in normal eyes (70 ± 3%, p < 0.001). The differences among subgroups of retinal dystrophy were not statistically significant (p = 0.084). All types of retinal dystrophy were associated with lower CVI (all p < 0.001), after adjusting for age, gender, visual acuity and duration of symptoms. Older age was also shown to be independently associated with lower CVI (p = 0.012). Gender, visual acuity (VA) and duration of symptoms did not significantly affect CVI. CONCLUSION Decreased choroidal vascularity was seen in eyes with retinal dystrophies. (CVI) may be a helpful tool in monitoring choroidal involvement in retinal dystrophies.
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Affiliation(s)
- Xin Wei
- Khoo Teck Puat Hospital; Singapore Singapore
| | | | | | | | - Neha Khandelwal
- National Healthcare Group Eye Institute; Tan Tock Seng Hospital; Singapore Singapore
| | | | - Rupesh Agrawal
- National Healthcare Group Eye Institute; Tan Tock Seng Hospital; Singapore Singapore
- Moorfields Eye Hospital; NHS Foundation Trust; London UK
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Kumawat D, Kumar V. Double trouble: exudative hypertensive retinopathy in a patient with retinitis pigmentosa. BMJ Case Rep 2018; 2018:bcr-2018-226950. [PMID: 30413460 DOI: 10.1136/bcr-2018-226950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A young female suffering from chronic kidney disease presented with retinal features suggestive of retinitis pigmentosa (RP). Cystoid intraretinal changes were noted at the macula in both eyes on optical coherence tomography. Careful clinical examination and fluorescein angiography revealed disc oedema, macular hard exudates and flower petal leakage in both eyes. A clinical diagnosis of RP with leaking cystoid macular oedema (CMO) because of hypertensive retinopathy was made. Exudation and macular oedema subsided with hypertension control and posterior sub-Tenon steroid injection. Although CMO does not typically leak on fluorescein angiography in RP, this need not always be true. Clinical signs and fluorescein angiography help in the differentiation of macular oedema when more than one aetiology may be responsible.
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Affiliation(s)
- Devesh Kumawat
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Borrelli E, Sarraf D, Freund KB, Sadda SR. OCT angiography and evaluation of the choroid and choroidal vascular disorders. Prog Retin Eye Res 2018; 67:30-55. [DOI: 10.1016/j.preteyeres.2018.07.002] [Citation(s) in RCA: 169] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 07/18/2018] [Accepted: 07/24/2018] [Indexed: 12/31/2022]
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Golubnitschaja O, Flammer J. Individualised patient profile: clinical utility of Flammer syndrome phenotype and general lessons for predictive, preventive and personalised medicine. EPMA J 2018. [PMID: 29515684 PMCID: PMC5833886 DOI: 10.1007/s13167-018-0127-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This case report introduces a female patient, who since her teenager age evidently suffers from Flammer syndrome (FS) as the clearly defined sub-optimal health condition. Further, the patient has experienced collateral pathological conditions which primarily might be linked to the family (genetic) predisposition, but the development of which could be synergistically promoted by the FS-phenotype. The facts are thoroughly analysed and consequent hypotheses are presented, which are indicative for highly desirable predictive diagnostics and targeted preventive measures to be created based on the accurate interpretation of the individualised patient profile. The authors emphasise the great clinical relevance of the FS and field-related research.
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Affiliation(s)
- Olga Golubnitschaja
- 1Radiological Clinic, Rheinische Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Str 25, 53105 Bonn, Germany.,2Breast Cancer Research Centre, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany.,3Centre for Integrated Oncology, Cologne-Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Josef Flammer
- 4Department of Ophthalmology, University of Basel, Basel, Switzerland
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Mastropasqua R, Borrelli E, Agnifili L, Toto L, Di Antonio L, Senatore A, Palmieri M, D'Uffizi A, Carpineto P. Radial Peripapillary Capillary Network in Patients with Retinitis Pigmentosa: An Optical Coherence Tomography Angiography Study. Front Neurol 2017; 8:572. [PMID: 29163338 PMCID: PMC5663731 DOI: 10.3389/fneur.2017.00572] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 10/12/2017] [Indexed: 01/08/2023] Open
Abstract
Purpose To investigate radial peripapillary capillary (RPC) network in patients affected by retinitis pigmentosa (RP). Methods Eleven patients (22 eyes) with previous diagnosis of RP and 16 age-matched healthy subjects (16 eyes) were enrolled. The diagnosis of RP was made based on both clinical features and electrophysiological examination. All patients underwent a complete ophthalmologic examination, including optical coherence tomography angiography and visual field (VF). The primary outcomes were the RPC vessel density in the peripapillary and disk areas; the secondary outcomes were the peripapillary retinal nerve fiber layer (RNFL) thickness and the mean defect at VF. Results A total of 19 eyes of 11 RP patients (5 males, 6 females) and 16 eyes of 16 healthy subjects (10 males, 6 females) were included for the analysis. RPC vessel density in the disk area was 46.5 ± 7.1% in the RP group and 45.4 ± 10.6% in the control group (p = 0.754). RPC vessel density in the peripapillary area was significantly reduced in the RP group after the comparison with the control group (52.5 ± 5.0 and 57.2 ± 5.1%, respectively, p = 0.011). RNFL thickness was 85.9 ± 20.4 μm in the RP group and 104.0 ± 6.4 μm in the control group (p = 0.002). RPC vessel density was significantly correlated with RNFL thickness values in RP patients, both in the disk and in the peripapillary area (Rho = 0.599 and p = 0.007 in the disk area, Rho = 0.665 and p = 0.002 in the peripapillary area, respectively). Conclusion We showed that density of RPC is reduced in these patients in the peripapillary area. Moreover, the RPC vessel density correlates with the RNFL thickness.
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Affiliation(s)
| | - Enrico Borrelli
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy.,Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, CA, United States.,Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Luca Agnifili
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Lisa Toto
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Luca Di Antonio
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Alfonso Senatore
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Michele Palmieri
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Alessandro D'Uffizi
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Paolo Carpineto
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
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Konieczka K, Erb C. Diseases potentially related to Flammer syndrome. EPMA J 2017; 8:327-332. [PMID: 29209435 PMCID: PMC5700007 DOI: 10.1007/s13167-017-0116-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 08/22/2017] [Indexed: 02/03/2023]
Abstract
Flammer syndrome (FS) is a prevalent and mostly benign condition. Subjects with FS seem to have a good life expectancy. Nevertheless, FS subjects are at increased risk for certain diseases, mainly when they are challenged by psychological stress or other stimuli such as coldness. FS is related to ocular diseases, such as normal-tension glaucoma, retinitis pigmentosa, central serous chorioretinopathy, optic nerve compartment syndrome, Leber’s hereditary optic neuropathy, arterial or venous occlusions in the retina, and choroid and optic nerve head, despite the absence of classical vascular risk factors. FS is also related to some non-ocular diseases, such as multiple sclerosis, breast cancer, and altitude sickness. The role of FS in other diseases such as tinnitus, sudden hearing loss, Ménière’s disease, anorexia nervosa, and thyroid dysfunction is currently under investigation. The exact relationship of FS to related diseases however still needs to be established. This may hopefully lead to more targeted diagnostics and personalized treatments.
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Affiliation(s)
- Katarzyna Konieczka
- Department of Ophthalmology, University of Basel, Mittlere Strasse 91, CH-4031 Basel, Switzerland
| | - Carl Erb
- Eye Clinic Wittenbergplatz, Berlin, Germany
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Todorova MG. Metabolic, structural and functional alterations in patients with inherited diseases of the retina. Acta Ophthalmol 2017. [DOI: 10.1111/aos.13524] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Blechschmidt T, Krumsiek M, Todorova MG. Acupuncture benefits for Flammer syndrome in individuals with inherited diseases of the retina. EPMA J 2017; 8:177-185. [PMID: 28725294 PMCID: PMC5486528 DOI: 10.1007/s13167-017-0096-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 05/15/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients with inherited diseases of the retina (IRD) often exhibit signs and symptoms of Flammer syndrome (FS). Acupuncture treatment has shown its positive effect on visual function in patients with IRD. The aim of the present study is to examine the effect of acupuncture on signs and symptoms of FS in a cohort of patients suffering simultaneously FS and IRD. PATIENTS AND METHODS A prospective pilot study was performed on 17 patients with FS and IRD: rod-cone dystrophy, Nr: 12 (RCD); cone-rod dystrophy, Nr: 3 (CRD) and inherited macular dystrophy, Nr: 2 (IMD; 12♀, 5♂; mean age: 44.19 y; SD ±17.09 y). Acupuncture treatment was done applying needle acupuncture of the body and the ears. The treatment was scheduled at 10 half-hour sessions over 5 weeks. Primary outcome was evaluation of the post-acupuncture effect on the signs and symptoms of FS in IRD patients using multiple-choice questionnaires. RESULTS Following acupuncture, we found improvement in signs and symptoms of FS in patients suffering simultaneously IRD, as for instance (Nr. patients: improvement/suffering/total): a reduced tiredness (10/11/17), shorter sleep onset time (10/11/17), warmer feet and hands (10/10/17) and reduced frequency of headache attacks (9/11/17). Surprisingly, in four RCD patients and in one IMD patient, a reduction of macular edema was documented. CONCLUSIONS The applied acupuncture protocol for FS in IRD patients showed improvement in FS signs and symptoms and was tolerated well. Nevertheless, the objective evaluation of this complementary therapy on FS in IRD patients remains to be elucidated.
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Affiliation(s)
- Tilo Blechschmidt
- Department of Ophthalmology, University of Basel, Mittlere Strasse 91, CH-4031 Basel, Switzerland
| | - Maike Krumsiek
- Department of Ophthalmology, University of Basel, Mittlere Strasse 91, CH-4031 Basel, Switzerland
| | - Margarita G Todorova
- Department of Ophthalmology, University of Basel, Mittlere Strasse 91, CH-4031 Basel, Switzerland
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Abstract
BACKGROUND Besides intraocular pressure, vascular factors play a role in the pathogenesis of glaucomatous optic neuropathy. One of these potential vascular factors is Flammer syndrome. The purpose of the present study was to determine in a Korean population whether signs and symptoms of Flammer syndrome occur more often in normal tension glaucoma patients than in control subjects. METHODS Two hundred forty-six normal tension glaucoma patients and 1116 control subjects responded to a multiple-choice questionnaire asking about 15 signs and symptoms of Flammer syndrome. RESULTS Seven of the 15 signs and symptoms of Flammer syndrome (increased drug sensitivity, good smell perception, reversible skin blotches, tinnitus, long sleep onset time, tendency to perfectionism, and cold hands/feet) were significantly more often positive in normal tension glaucoma patients than in controls. Six additional signs and symptoms (migraines, low blood pressure, headaches, dizziness, increased pain sensation, and feeling cold) also occurred more often, but did not reach statistical significance. Only two items (low body weight and reduced feeling of thirst) were more frequently (not significant) positive in the controls. CONCLUSION There is an association between normal tension glaucoma and Flammer syndrome. If future studies confirm this relationship, treatment of Flammer syndrome may help to prevent normal tension glaucoma or to slow down its progression.
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Zubor P, Gondova A, Polivka J, Kasajova P, Konieczka K, Danko J, Golubnitschaja O. Breast cancer and Flammer syndrome: any symptoms in common for prediction, prevention and personalised medical approach? EPMA J 2017; 8:129-140. [PMID: 28824738 PMCID: PMC5545996 DOI: 10.1007/s13167-017-0089-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 03/14/2017] [Indexed: 12/18/2022]
Abstract
An epidemic scale of the breast cancer (BC) prevalence is actually recognised as the reality of the early twenty-first century. Particularly alarming is that the sporadic BC (about 90% of all patients) creates currently unpredictable subpopulations in terms of disease predisposition, development and progression. Despite broad discussions run since years in BC area, no any plausible approach has been suggested so far to get the overall situation better controlled in the populations. Here, we present highly innovative concepts considering investigation of specific syndromes and symptoms underestimated till now in relationship with BC predisposition and development. Consequently, the purpose of our pilot project was to evaluate the prevalence of Flammer Syndrome (FS) in BC patient cohort. The results achieved here support the main hypothesis of the project clearly demonstrating the tendency of BC patients to the increased prevalence of FS symptoms compared to the disease-free individuals. Our study strongly indicates the relevance of FS symptoms for BC pathology such as feeling inadequately cold, deficient thermoregulation, altered sensitivity to different stimuli, potential dehydration, altered sleep patterns, tendency towards headache, migraine attacks and dizziness. Moreover, the symptoms' appearance is specifically linked to the individual BC subtypes. Potential mechanisms interconnecting FS with BC pathology are discussed.
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Affiliation(s)
- Pavol Zubor
- Department of Obstetrics and Gynaecology, Jessenius Faculty of Medicine, Martin University Hospital, Martin, Slovak Republic
- Division of Oncology, Biomedical Centre Martin, Jessenius Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovak Republic
| | - Alexandra Gondova
- Department of Obstetrics and Gynaecology, Jessenius Faculty of Medicine, Martin University Hospital, Martin, Slovak Republic
| | - Jiri Polivka
- Department of Histology and Embryology and Biomedical Center, Faculty of Medicine in Plzen, Charles University, Prague, Czech Republic
- Department of Neurology, Faculty Hospital Plzen, Prague, Czech Republic
| | - Petra Kasajova
- Department of Obstetrics and Gynaecology, Jessenius Faculty of Medicine, Martin University Hospital, Martin, Slovak Republic
| | | | - Jan Danko
- Department of Obstetrics and Gynaecology, Jessenius Faculty of Medicine, Martin University Hospital, Martin, Slovak Republic
| | - Olga Golubnitschaja
- Radiological clinic, Rheinische Friedrich-Wilhelms-University of Bonn, Sigmund-Freud-Str 25, 53105 Bonn, Germany
- Breast Cancer Research Centre, Rheinische Friedrich-Wilhelms-University of Bonn, Bonn, Germany
- Centre for Integrated Oncology, Cologne-Bonn, Rheinische Friedrich-Wilhelms-University of Bonn, Bonn, Germany
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Flammer J, Konieczka K. The discovery of the Flammer syndrome: a historical and personal perspective. EPMA J 2017; 8:75-97. [PMID: 28725290 PMCID: PMC5486542 DOI: 10.1007/s13167-017-0090-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 03/27/2017] [Indexed: 12/21/2022]
Abstract
This review describes the clinical and basic research that led to the description of Flammer syndrome. It is narrated from a personal perspective. This research was initiated by the observation of an increased long-term fluctuation of visual fields in a subgroup of glaucoma patients. As these patients had strikingly cold hands, peripheral blood flow was tested with a capillary microscopy, and vasospastic syndrome (VS) was diagnosed. Further studies on these patients revealed frequently weakened autoregulation of ocular blood flow and increased flow resistivity in retroocular vessels. Their retinal vessels were more rigid and irregular and responded less to flickering light. Holistic investigation demonstrated low blood pressure, silent myocardial ischaemia, altered beat-to-beat variation, altered gene expression in the lymphocytes, slightly increased plasma endothelin level and increased systemic oxidative stress. This combination of signs and symptoms was better described by the term primary vascular dysregulation (PVD) than by VS. Subsequent studies showed additional symptoms frequently related to PVD, such as low body mass index, cold extremities combined with slightly increased core temperature, prolonged sleep onset time, reduced feelings of thirst, increased sensitivity to smell and also for certain drugs and increased retinal venous pressure. To better characterise this entire syndrome, the term Flammer syndrome (FS) was introduced. Most subjects with FS were healthy. Nevertheless, FS seemed to increase the risk for certain eye diseases, particularly in younger patients. This included normal-tension glaucoma, anterior ischaemic optic neuropathy, retinal vein occlusions, Susac syndrome and central serous chorioretinopathy. Hereditary diseases, such as Leber’s optic neuropathy or retinitis pigmentosa, were also associated with FS, and FS symptoms and sings occurred more frequent in patients with multiple sclerosis or with acute hearing loss. Further research should lead to a more concise definition of FS, a precise diagnosis and tools for recognizing people at risk for associated diseases. This may ultimately lead to more efficient and more personalised treatment.
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Affiliation(s)
- Josef Flammer
- Department of Ophthalmology, University of Basel, Mittlere Strasse 91, CH-4031 Basel, Switzerland
| | - Katarzyna Konieczka
- Department of Ophthalmology, University of Basel, Mittlere Strasse 91, CH-4031 Basel, Switzerland
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Konieczka K, Koch S, Binggeli T, Schoetzau A, Kesselring J. Multiple sclerosis and primary vascular dysregulation (Flammer syndrome). EPMA J 2016; 7:13. [PMID: 27307797 PMCID: PMC4908696 DOI: 10.1186/s13167-016-0062-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 05/26/2016] [Indexed: 01/28/2023]
Abstract
Background Multiple sclerosis (MS) is an inflammatory demyelinating disease of the CNS of still unknown aetiology. Flammer syndrome (FS) encompasses a set of symptoms and signs that are primarily but not solely related to the dysregulation of blood vessels. The purpose of the present study was to determine whether FS symptoms occur more often in MS patients than in controls. Methods Fifty-eight MS patients and 259 controls answered a questionnaire covering 15 symptoms and signs of FS. Results Six of the 15 symptoms and signs of FS (dizziness, low body mass index, cold hands and/or feet, tendency toward perfectionism, reduced thirst, feeling cold) were found significantly more often in MS patients than in controls. Seven additional symptoms and signs (tinnitus, headaches, increased pain sensation, long sleep-onset time, migraines, increased response to certain drugs, low blood pressure) also occurred more often in MS patients, but the difference in frequency was not statistically significant. One sign (reversible skin blotches) was found less often in MS patients, but the difference in frequency was not statistically significant. One symptom (increased smell perception) was found significantly less often in MS patients. Conclusions MS patients suffer significantly more often from FS symptoms and signs than controls. The reason for this association between MS and FS and the potential implications of this association still need to be determined.
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Affiliation(s)
- Katarzyna Konieczka
- Department of Ophthalmology, University of Basel, Mittlere Strasse 91, CH-4031 Basel, Switzerland
| | - Simone Koch
- Department of Ophthalmology, University of Basel, Mittlere Strasse 91, CH-4031 Basel, Switzerland
| | - Tatjana Binggeli
- Department of Ophthalmology, University of Basel, Mittlere Strasse 91, CH-4031 Basel, Switzerland
| | - Andreas Schoetzau
- Department of Ophthalmology, University of Basel, Mittlere Strasse 91, CH-4031 Basel, Switzerland
| | - Juerg Kesselring
- Department of Neurology and Neurorehabilitation, Rehabilitation Centre Valens, Valens, Switzerland
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Yang GQ, Chen T, Tao Y, Zhang ZM. Recent advances in the dark adaptation investigations. Int J Ophthalmol 2015; 8:1245-52. [PMID: 26682182 DOI: 10.3980/j.issn.2222-3959.2015.06.31] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 01/28/2015] [Indexed: 12/15/2022] Open
Abstract
Dark adaptation is a highly sensitive neural function and may be the first symptom of many status including the physiologic and pathologic entity, suggesting that it could be instrumental for diagnose. However, shortcomings such as the lack of standardized parameters, the long duration of examination, and subjective randomness would substantially impede the use of dark adaptation in clinical work. In this review we summarize the recent research about the dark adaptation, including two visual cycles-canonical and cone-specific visual cycle, affecting factors and the methods for measuring dark adaptation. In the opinions of authors, intensive investigations are needed to be done for the widely use of this significant visual function in clinic.
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Affiliation(s)
- Guo-Qing Yang
- Department of Clinical Aerospace Medicine, the Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China
| | - Tao Chen
- Department of Clinical Aerospace Medicine, the Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China
| | - Ye Tao
- Department of Ophthalmology, Beidaihe Hospital of PLA, Beidaihe 066100, Hebei Province, China
| | - Zuo-Ming Zhang
- Department of Clinical Aerospace Medicine, the Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China
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The Role of the Endothelin System in the Vascular Dysregulation Involved in Retinitis Pigmentosa. J Ophthalmol 2015; 2015:405234. [PMID: 26613048 PMCID: PMC4647052 DOI: 10.1155/2015/405234] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 10/18/2015] [Indexed: 12/31/2022] Open
Abstract
Retinitis pigmentosa is a clinical and genetic group of inherited retinal disorders characterized by alterations of photoreceptors and retinal pigment epithelium leading to a progressive concentric visual field restriction, which may bring about severe central vision impairment. Haemodynamic studies in patients with retinitis pigmentosa have demonstrated ocular blood flow abnormalities both in retina-choroidal and in retroocular vascular system. Moreover, several investigations have studied the augmentation of endothelin-1 plasma levels systemically in the body and locally in the eye. This might account for vasoconstriction and ischemia, typical in vascular dysregulation syndrome, which can be considered an important factor of reduction of the ocular blood flow in subjects affected by retinitis pigmentosa.
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Chhablani J, Jonnadula GB, Srinivasa Rao P, Venkata A, Jalali S. Choroidal thickness profile in Retinitis Pigmentosa - Correlation with outer retinal structures. Saudi J Ophthalmol 2015; 30:9-13. [PMID: 26949351 PMCID: PMC4759516 DOI: 10.1016/j.sjopt.2015.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 08/12/2015] [Accepted: 09/14/2015] [Indexed: 11/21/2022] Open
Abstract
Purpose To compare the choroidal thickness (CT) of subjects with Retinitis Pigmentosa (RP) with age-matched healthy subjects and to correlate the visual acuity with retinal parameters including central macular thickness (CMT), inner segment/outer segment junction (IS/OS junction) integrity, external limiting membrane (ELM) integrity and choroidal thickness in subjects with RP. Methods Eighty-eight eyes (69 patients) with typical RP and 188 eyes of 104 healthy subjects were enrolled between September 2012 and January 2013. All subjects underwent a comprehensive ocular examination including choroidal imaging using enhanced depth imaging with spectral domain optical coherence tomography. Outcome measures were CT difference between RP and age-matched healthy subjects; and correlation of various factors such CMT, IS/OS junction integrity, ELM integrity, and CT with visual acuity. Results Among RP subjects, mean age was 31.39 ± 13.4 years with a mean BCVA of 0.99 ± 0.94 logMAR. Mean spherical equivalent was −0.6 ± 1.6D. Mean CMT was 148.48 ± 119 μm. Mean subfoveal CT was 296.9 ± 72 μm. Mean IS/OS and ELM integrity was 42.2 ± 46.6% and 43.75 ± 45.7%, respectively. The mean age was 40.0 ± 13.5 years with a mean spherical equivalent of 0.18 ± 0.6D for the normal age-matched healthy group. Mean subfoveal CT was 283.1 ± 47.8 μm. CT at various locations in patients of various ages in the RP group did not show any statistical significant difference (P = ≫0.05) in comparison with age-matched healthy subjects. On multivariate regression, ELM percentage integrity had the strongest association with best corrected visual acuity, followed by IS/OS junction percentage integrity. Subfoveal choroidal thickness had very weak correlation with visual acuity as well other retinal parameters. There was a significant difference in the outer retinal structure integrity (p = 0.002) and CMT (p = 0.02) between the eyes with good (⩾20/200) and poor vision (<20/200), but not in subfoveal choroidal thickness (p = 0.3). Conclusions Our study results did not show any significant difference in choroidal thickness between subjects with RP and age-matched healthy subjects. Choroidal thickness correlated better with the age but not with the vision or outer retinal structures in eyes with RP. Outer retinal structure integrity and CMT had a better correlation with visual acuity.
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Affiliation(s)
- Jay Chhablani
- Smt. Kanuri Santhamma Retina Vitreous Centre, L.V. Prasad Eye Institute, Kallam Anji Reddy Campus, L.V. Prasad Marg, Banjara Hills, Hyderabad 500 034, Andhra Pradesh, India
- Corresponding author.
| | - Ganesh Babu Jonnadula
- Smt. Kanuri Santhamma Retina Vitreous Centre, L.V. Prasad Eye Institute, Kallam Anji Reddy Campus, L.V. Prasad Marg, Banjara Hills, Hyderabad 500 034, Andhra Pradesh, India
| | - P. Srinivasa Rao
- L.V. Prasad Eye Institute, Kode Venkatadri Chowdary Campus, Tadigadapa, Vijayawada 521137, Andhra Pradesh, India
| | - Amarnath Venkata
- Smt. Kanuri Santhamma Retina Vitreous Centre, L.V. Prasad Eye Institute, Kallam Anji Reddy Campus, L.V. Prasad Marg, Banjara Hills, Hyderabad 500 034, Andhra Pradesh, India
| | - Subhadra Jalali
- Smt. Kanuri Santhamma Retina Vitreous Centre, L.V. Prasad Eye Institute, Kallam Anji Reddy Campus, L.V. Prasad Marg, Banjara Hills, Hyderabad 500 034, Andhra Pradesh, India
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Kiseleva TN, Zol'nikova IV, Demenkova ON, Ramazanova KA, Egorova IV, Rogatina EV, Rogova SY, Kiseleva TN, Zol'nikova IV, Demenkova ON, Ramazanova KA, Egorova IV, Rogatina EV, Rogova SY. [Ocular blood flow and retinal electrogenesis in retinitis pigmentosa]. Vestn Oftalmol 2015; 131:14-19. [PMID: 26845867 DOI: 10.17116/oftalma2015131514-19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM to investigate correlations between changes in ocular hemodynamics revealed by color Doppler flow mapping (CDFM) and pulsed-wave (PW) Doppler imaging, one the one hand, and electrical activity of the retina, on the other, in patients with early, moderate, and severe retinitis pigmentosa (RP). MATERIAL AND METHODS A total of 20 patients (40 eyes) aged from 16 to 40 years (28.4 ± 8.2 years on average) with retinitis pigmentosa were enrolled. The control group consisted of 20 healthy volunteers of the same age range. All participants underwent full-field electroretinography (ERG), flicker ERG, and macular ERG as well as blood flow assessment in the ophthalmic artery (OA), central retinal artery (CRA), and short posterior ciliary arteries (SPCA) by means of CDFM and PW-Doppler. RESULTS Ocular blood flow in CRA and SPCA appeared disturbed in patients with early RP. In cases of moderate and severe RP, the peak systolic velocity of CRA and SPCA blood flow was significantly decreased. Systolic and end diastolic blood flow velocities in CRA and SPCA has been shown to be directly related to full-field ERG a-wave and b-wave amplitudes, correspondingly, but negatively correlated with their implicit times. CONCLUSION The revealed decrease in CRA and SPCA blood flow indices proves retinal and choroidal circulation deficit in patients with advanced RP. As shown, moderate blood flow changes are already present in early RP and progress as retinal photoreceptors and bipolar cells become suppressed, which may be useful for RP diagnosis and monitoring.
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Affiliation(s)
- T N Kiseleva
- Moscow Helmholtz Research Institute of Eye Diseases, Ministry of Health of the Russian Federation, 14/19 Sadovaya-Chernogryazskaya St., Moscow, Russian Federation, 105062
| | - I V Zol'nikova
- Moscow Helmholtz Research Institute of Eye Diseases, Ministry of Health of the Russian Federation, 14/19 Sadovaya-Chernogryazskaya St., Moscow, Russian Federation, 105062
| | - O N Demenkova
- Moscow Helmholtz Research Institute of Eye Diseases, Ministry of Health of the Russian Federation, 14/19 Sadovaya-Chernogryazskaya St., Moscow, Russian Federation, 105062
| | - K A Ramazanova
- Moscow Helmholtz Research Institute of Eye Diseases, Ministry of Health of the Russian Federation, 14/19 Sadovaya-Chernogryazskaya St., Moscow, Russian Federation, 105062
| | - I V Egorova
- Moscow Helmholtz Research Institute of Eye Diseases, Ministry of Health of the Russian Federation, 14/19 Sadovaya-Chernogryazskaya St., Moscow, Russian Federation, 105062
| | - E V Rogatina
- Moscow Helmholtz Research Institute of Eye Diseases, Ministry of Health of the Russian Federation, 14/19 Sadovaya-Chernogryazskaya St., Moscow, Russian Federation, 105062
| | - S Yu Rogova
- Moscow Helmholtz Research Institute of Eye Diseases, Ministry of Health of the Russian Federation, 14/19 Sadovaya-Chernogryazskaya St., Moscow, Russian Federation, 105062
| | - T N Kiseleva
- Moscow Helmholtz Research Institute of Eye Diseases, Ministry of Health of the Russian Federation, 14/19 Sadovaya-Chernogryazskaya St., Moscow, Russian Federation, 105062
| | - I V Zol'nikova
- Moscow Helmholtz Research Institute of Eye Diseases, Ministry of Health of the Russian Federation, 14/19 Sadovaya-Chernogryazskaya St., Moscow, Russian Federation, 105062
| | - O N Demenkova
- Moscow Helmholtz Research Institute of Eye Diseases, Ministry of Health of the Russian Federation, 14/19 Sadovaya-Chernogryazskaya St., Moscow, Russian Federation, 105062
| | - K A Ramazanova
- Moscow Helmholtz Research Institute of Eye Diseases, Ministry of Health of the Russian Federation, 14/19 Sadovaya-Chernogryazskaya St., Moscow, Russian Federation, 105062
| | - I V Egorova
- Moscow Helmholtz Research Institute of Eye Diseases, Ministry of Health of the Russian Federation, 14/19 Sadovaya-Chernogryazskaya St., Moscow, Russian Federation, 105062
| | - E V Rogatina
- Moscow Helmholtz Research Institute of Eye Diseases, Ministry of Health of the Russian Federation, 14/19 Sadovaya-Chernogryazskaya St., Moscow, Russian Federation, 105062
| | - S Yu Rogova
- Moscow Helmholtz Research Institute of Eye Diseases, Ministry of Health of the Russian Federation, 14/19 Sadovaya-Chernogryazskaya St., Moscow, Russian Federation, 105062
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ET-1 Plasma Levels, Aqueous Flare, and Choroidal Thickness in Patients with Retinitis Pigmentosa. J Ophthalmol 2015; 2015:292615. [PMID: 26137317 PMCID: PMC4468344 DOI: 10.1155/2015/292615] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 12/09/2014] [Accepted: 12/15/2014] [Indexed: 11/17/2022] Open
Abstract
Purpose. To assess endothelin-1 (ET-1) plasma levels, choroidal thickness, and aqueous flare in patients with early stage retinitis pigmentosa (RP) and to search for possible correlations. Methods. We compared 24 RP patients with 24 healthy controls. Choroidal thickness and aqueous flare were measured, respectively, by using a spectral domain optical coherence tomography and a laser flare-cell meter, whereas plasma samples were obtained from each patient to evaluate ET-1 plasma levels. Results. Notably, RP subjects showed significantly increased ET-1 plasma levels and reduced choroidal thickness compared with controls: 2.143 ± 0.258 versus 1.219 ± 0.236 pg/mL, P < 0.002, and 226.75 ± 76.37 versus 303.9 ± 39.87 μm, P < 0.03, respectively. Higher aqueous flare values were also demonstrated in RP compared to controls: in detail, 10.51 ± 3.97 versus 5.66 ± 1.29 photon counts/ms, P < 0.0001. Spearman's correlation test highlighted that the increase of ET-1 plasma levels was related with the decrease of choroidal thickness (r = -0.702; P < 0.023) and the increase of aqueous flare (r = 0.580; P < 0.007). Conclusions. Early stage RP patients show a breakdown of blood-ocular barrier and increased ET-1 plasma levels and these findings may contribute to the reduction of choroidal thickness.
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Türksever C, Valmaggia C, Orgül S, Schorderet DF, Flammer J, Todorova MG. Retinal vessel oxygen saturation and its correlation with structural changes in retinitis pigmentosa. Acta Ophthalmol 2014; 92:454-60. [PMID: 24767408 DOI: 10.1111/aos.12379] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 01/29/2014] [Indexed: 12/15/2022]
Abstract
PURPOSE To study the influence of retinal structural changes on oxygen saturation in retinitis pigmentosa (RP) patients. METHODS Oximetry measurements were performed on 21 eyes of 11 RP patients and compared to 24 eyes of 12 controls. Retinal oxygen saturation was measured in all major retinal arterioles (A-SO₂) and venules (V-SO₂) with an oximetry unit of the retinal vessel analyser (IMEDOS Systems UG, Jena, Germany). Oximetry data were compared with morphological changes measured by Cirrus optical coherence tomography (OCT) (Carl Zeiss Meditec, Dublin, CA, USA, macular thickness protocol). RESULTS In RP patients, the retinal A-SO₂ and V-SO₂ levels were higher at 99.3% (p = 0.001, anova based on mixed-effects model) and 66.8% (p < 0.001), respectively, and the difference between the two (A-V SO₂) was lower at 32.5% (p < 0.001), when compared to the control group (92.4%; 54.0%; 38.4%, respectively). With the RP group, the A-V SO₂ correlated positively, not only with central macular thickness, but also with retinal thickness, in zones 2 and 3 (p = 0.006, p = 0.007, p = 0.014). CONCLUSION These data indicate that oxygen metabolism was altered in RP patients. Based on our preliminary results, retinal vessel saturation correlated with structural alterations in RP. This method could be valuable in monitoring disease progression and evaluating a potential therapeutic response.
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Affiliation(s)
- Cengiz Türksever
- Department of Ophthalmology; University of Basel; Basel Switzerland
| | | | - Selim Orgül
- Department of Ophthalmology; University of Basel; Basel Switzerland
| | - Daniel F. Schorderet
- IRO - Institut for Research in Ophthalmology; Sion Switzerland
- Department of Ophthalmology; University of Lausanne; Lausanne Switzerland
- School of Life Sciences; Federal Institute of Technology; Lausanne Switzerland
| | - Josef Flammer
- Department of Ophthalmology; University of Basel; Basel Switzerland
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Finzi A, Cellini M, Strobbe E, Campos EC. ET-1 plasma levels, choroidal thickness and multifocal electroretinogram in retinitis pigmentosa. Life Sci 2014; 118:386-90. [PMID: 24735956 DOI: 10.1016/j.lfs.2014.04.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 03/14/2014] [Accepted: 04/03/2014] [Indexed: 12/31/2022]
Abstract
AIM To assess the relationship between both photoreceptor function and choroidal thickness and endothelin-1 (ET-1) plasma levels in patients with early stage retinitis pigmentosa (RP). MAIN METHODS We compared 24 RP patients (14 males and 10 females), 25 to 42 years of age (mean age: 34±7 years) with 24 healthy controls (12 males and 12 females) aged between 28 and 45 years (mean 36±6.8 years). All patients underwent visual field test, electroretinogram and multifocal-electroretinogram and choroidal thickness measurement by using spectral domain optical coherence tomography. KEY FINDINGS RP patients had a visual acuity of 0.95, a mean defect of the visual field of -7.90±1.75 dB, a pattern standard deviation index of 6.09±4.22 dB and a b-wave ERG amplitude of 45.08±8.24 μV. Notably RP subjects showed significantly increased ET-1 plasma levels and reduced choroidal thickness compared with controls: respectively, 2.143±0.258 pg/ml vs. 1.219±0.236 pg/ml; p<0.002 and 226.75±76.37 μm vs. 303.9±39.87 μm; p<0.03. Spearman's correlation test highlighted that the increase of ET-1 plasma levels was related with the decrease of choroidal thickness (r=-0.702; p<0.023) and the increase of implicit time in both ring 2 (r=-0.669; p<0.034) and ring 3 (r=-0.883; p<0.007) of mfERG. SIGNIFICANCE Increased ET-1 plasma levels may play a key role in the impairment of retinal and choroidal blood flow due to the vasoconstriction induced by ET-1. This could lead to worsening of the abiotrophic process of the macular photoreceptors.
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Affiliation(s)
- Alessandro Finzi
- Department of Specialized, Diagnostic and Experimental Medicine, Ophthalmology Service, University of Bologna, Bologna, Italy.
| | - Mauro Cellini
- Department of Specialized, Diagnostic and Experimental Medicine, Ophthalmology Service, University of Bologna, Bologna, Italy
| | - Ernesto Strobbe
- Department of Specialized, Diagnostic and Experimental Medicine, Ophthalmology Service, University of Bologna, Bologna, Italy
| | - Emilio C Campos
- Department of Specialized, Diagnostic and Experimental Medicine, Ophthalmology Service, University of Bologna, Bologna, Italy
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Froger N, Moutsimilli L, Cadetti L, Jammoul F, Wang QP, Fan Y, Gaucher D, Rosolen SG, Neveux N, Cynober L, Sahel JA, Picaud S. Taurine: the comeback of a neutraceutical in the prevention of retinal degenerations. Prog Retin Eye Res 2014; 41:44-63. [PMID: 24721186 DOI: 10.1016/j.preteyeres.2014.03.001] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 03/11/2014] [Accepted: 03/12/2014] [Indexed: 12/21/2022]
Abstract
Taurine is the most abundant amino acid in the retina. In the 1970s, it was thought to be involved in retinal diseases with photoreceptor degeneration, because cats on a taurine-free diet presented photoreceptor loss. However, with the exception of its introduction into baby milk and parenteral nutrition, taurine has not yet been incorporated into any commercial treatment with the aim of slowing photoreceptor degeneration. Our recent discovery that taurine depletion is involved in the retinal toxicity of the antiepileptic drug vigabatrin has returned taurine to the limelight in the field of neuroprotection. However, although the retinal toxicity of vigabatrin principally involves a deleterious effect on photoreceptors, retinal ganglion cells (RGCs) are also affected. These findings led us to investigate the possible role of taurine depletion in retinal diseases with RGC degeneration, such as glaucoma and diabetic retinopathy. The major antioxidant properties of taurine may influence disease processes. In addition, the efficacy of taurine is dependent on its uptake into retinal cells, microvascular endothelial cells and the retinal pigment epithelium. Disturbances of retinal vascular perfusion in these retinal diseases may therefore affect the retinal uptake of taurine, resulting in local depletion. The low plasma taurine concentrations observed in diabetic patients may further enhance such local decreases in taurine concentration. We here review the evidence for a role of taurine in retinal ganglion cell survival and studies suggesting that this compound may be involved in the pathophysiology of glaucoma or diabetic retinopathy. Along with other antioxidant molecules, taurine should therefore be seriously reconsidered as a potential treatment for such retinal diseases.
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Affiliation(s)
- Nicolas Froger
- INSERM, U968, Institut de la Vision, Paris, France; Sorbonne Universités, Université Pierre et Marie Curie (Paris-6), UMR S 968, Institut de la Vision, Paris, France; CNRS, UMR 7210, Institut de la Vision, Paris, France.
| | - Larissa Moutsimilli
- INSERM, U968, Institut de la Vision, Paris, France; Sorbonne Universités, Université Pierre et Marie Curie (Paris-6), UMR S 968, Institut de la Vision, Paris, France; CNRS, UMR 7210, Institut de la Vision, Paris, France
| | - Lucia Cadetti
- INSERM, U968, Institut de la Vision, Paris, France; Sorbonne Universités, Université Pierre et Marie Curie (Paris-6), UMR S 968, Institut de la Vision, Paris, France; CNRS, UMR 7210, Institut de la Vision, Paris, France
| | - Firas Jammoul
- INSERM, U968, Institut de la Vision, Paris, France; Sorbonne Universités, Université Pierre et Marie Curie (Paris-6), UMR S 968, Institut de la Vision, Paris, France; CNRS, UMR 7210, Institut de la Vision, Paris, France
| | - Qing-Ping Wang
- INSERM, U968, Institut de la Vision, Paris, France; Sorbonne Universités, Université Pierre et Marie Curie (Paris-6), UMR S 968, Institut de la Vision, Paris, France; CNRS, UMR 7210, Institut de la Vision, Paris, France
| | - Yichao Fan
- INSERM, U968, Institut de la Vision, Paris, France; Sorbonne Universités, Université Pierre et Marie Curie (Paris-6), UMR S 968, Institut de la Vision, Paris, France; CNRS, UMR 7210, Institut de la Vision, Paris, France
| | - David Gaucher
- INSERM, U968, Institut de la Vision, Paris, France; Sorbonne Universités, Université Pierre et Marie Curie (Paris-6), UMR S 968, Institut de la Vision, Paris, France; CNRS, UMR 7210, Institut de la Vision, Paris, France; Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France; Nouvel hôpital civil, hôpitaux universitaires de Strasbourg and Laboratoire de Bactériologie (EA-7290), Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, France
| | - Serge G Rosolen
- INSERM, U968, Institut de la Vision, Paris, France; Sorbonne Universités, Université Pierre et Marie Curie (Paris-6), UMR S 968, Institut de la Vision, Paris, France; CNRS, UMR 7210, Institut de la Vision, Paris, France
| | - Nathalie Neveux
- Department of Nutrition, Faculty of Pharmacy, Paris Descartes University, Paris, France; Clinical Chemistry, Hôtel-Dieu-Cochin Hospitals, AP-HP, Paris, France
| | - Luc Cynober
- Department of Nutrition, Faculty of Pharmacy, Paris Descartes University, Paris, France; Clinical Chemistry, Hôtel-Dieu-Cochin Hospitals, AP-HP, Paris, France
| | - José-Alain Sahel
- INSERM, U968, Institut de la Vision, Paris, France; Sorbonne Universités, Université Pierre et Marie Curie (Paris-6), UMR S 968, Institut de la Vision, Paris, France; CNRS, UMR 7210, Institut de la Vision, Paris, France; Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France; Institute of Ophthalmology, University College of London, UK; Fondation Ophtalmologique Adolphe de Rothschild, Paris, France; French Academy of Sciences, Paris, France
| | - Serge Picaud
- INSERM, U968, Institut de la Vision, Paris, France; Sorbonne Universités, Université Pierre et Marie Curie (Paris-6), UMR S 968, Institut de la Vision, Paris, France; CNRS, UMR 7210, Institut de la Vision, Paris, France; Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.
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Flammer J, Konieczka K, Flammer AJ. The primary vascular dysregulation syndrome: implications for eye diseases. EPMA J 2013; 4:14. [PMID: 23742177 PMCID: PMC3693953 DOI: 10.1186/1878-5085-4-14] [Citation(s) in RCA: 196] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 04/26/2013] [Indexed: 01/08/2023]
Abstract
Vascular dysregulation refers to the regulation of blood flow that is not adapted to the needs of the respective tissue. We distinguish primary vascular dysregulation (PVD, formerly called vasospastic syndrome) and secondary vascular dysregulation (SVD). Subjects with PVD tend to have cold extremities, low blood pressure, reduced feeling of thirst, altered drug sensitivity, increased pain sensitivity, prolonged sleep onset time, altered gene expression in the lymphocytes, signs of oxidative stress, slightly increased endothelin-1 plasma level, low body mass index and often diffuse and fluctuating visual field defects. Coldness, emotional or mechanical stress and starving can provoke symptoms. Virtually all organs, particularly the eye, can be involved. In subjects with PVD, retinal vessels are stiffer and more irregular, and both neurovascular coupling and autoregulation capacity are reduced while retinal venous pressure is often increased. Subjects with PVD have increased risk for normal-tension glaucoma, optic nerve compartment syndrome, central serous choroidopathy, Susac syndrome, retinal artery and vein occlusions and anterior ischaemic neuropathy without atherosclerosis. Further characteristics are their weaker blood–brain and blood-retinal barriers and the higher prevalence of optic disc haemorrhages and activated astrocytes. Subjects with PVD tend to suffer more often from tinnitus, muscle cramps, migraine with aura and silent myocardial ischaemic and are at greater risk for altitude sickness. While the main cause of vascular dysregulation is vascular endotheliopathy, dysfunction of the autonomic nervous system is also involved. In contrast, SVD occurs in the context of other diseases such as multiple sclerosis, retrobulbar neuritis, rheumatoid arthritis, fibromyalgia and giant cell arteritis. Taking into consideration the high prevalence of PVD in the population and potentially linked pathologies, in the current article, the authors provide recommendations on how to effectively promote the field in order to create innovative diagnostic tools to predict the pathology and develop more efficient treatment approaches tailored to the person.
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Affiliation(s)
- Josef Flammer
- Department of Ophthalmology, University of Basel, Mittlere Strasse 91, Basel CH-4031, Switzerland.
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