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Ahmed H, Zhang Q, Donnan R, Alomainy A. Transformer enhanced autoencoder rendering cleaning of noisy optical coherence tomography images. J Med Imaging (Bellingham) 2024; 11:034008. [PMID: 38694626 PMCID: PMC11058346 DOI: 10.1117/1.jmi.11.3.034008] [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: 10/11/2023] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 05/04/2024] Open
Abstract
Purpose Optical coherence tomography (OCT) is an emerging imaging tool in healthcare with common applications in ophthalmology for detection of retinal diseases, as well as other medical domains. The noise in OCT images presents a great challenge as it hinders the clinician's ability to diagnosis in extensive detail. Approach In this work, a region-based, deep-learning, denoising framework is proposed for adaptive cleaning of noisy OCT-acquired images. The core of the framework is a hybrid deep-learning model named transformer enhanced autoencoder rendering (TEAR). Attention gates are utilized to ensure focus on denoising the foreground and to remove the background. TEAR is designed to remove the different types of noise artifacts commonly present in OCT images and to enhance the visual quality. Results Extensive quantitative evaluations are performed to evaluate the performance of TEAR and compare it against both deep-learning and traditional state-of-the-art denoising algorithms. The proposed method improved the peak signal-to-noise ratio to 27.9 dB, CNR to 6.3 dB, SSIM to 0.9, and equivalent number of looks to 120.8 dB for a dental dataset. For a retinal dataset, the performance metrics in the same sequence are: 24.6, 14.2, 0.64, and 1038.7 dB, respectively. Conclusions The results show that the approach verifiably removes speckle noise and achieves superior quality over several well-known denoisers.
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Affiliation(s)
- Hanya Ahmed
- Queen Mary University of London, School of Electronic Engineering and Computer Science, London, United Kingdom
| | - Qianni Zhang
- Queen Mary University of London, School of Electronic Engineering and Computer Science, London, United Kingdom
| | - Robert Donnan
- Queen Mary University of London, School of Engineering and Materials Science, London, United Kingdom
| | - Akram Alomainy
- Queen Mary University of London, School of Electronic Engineering and Computer Science, London, United Kingdom
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Ahmed H, Zhang Q, Donnan R, Alomainy A. Denoising of Optical Coherence Tomography Images in Ophthalmology Using Deep Learning: A Systematic Review. J Imaging 2024; 10:86. [PMID: 38667984 PMCID: PMC11050869 DOI: 10.3390/jimaging10040086] [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: 02/27/2024] [Revised: 03/22/2024] [Accepted: 03/24/2024] [Indexed: 04/28/2024] Open
Abstract
Imaging from optical coherence tomography (OCT) is widely used for detecting retinal diseases, localization of intra-retinal boundaries, etc. It is, however, degraded by speckle noise. Deep learning models can aid with denoising, allowing clinicians to clearly diagnose retinal diseases. Deep learning models can be considered as an end-to-end framework. We selected denoising studies that used deep learning models with retinal OCT imagery. Each study was quality-assessed through image quality metrics (including the peak signal-to-noise ratio-PSNR, contrast-to-noise ratio-CNR, and structural similarity index metric-SSIM). Meta-analysis could not be performed due to heterogeneity in the methods of the studies and measurements of their performance. Multiple databases (including Medline via PubMed, Google Scholar, Scopus, Embase) and a repository (ArXiv) were screened for publications published after 2010, without any limitation on language. From the 95 potential studies identified, a total of 41 were evaluated thoroughly. Fifty-four of these studies were excluded after full text assessment depending on whether deep learning (DL) was utilized or the dataset and results were not effectively explained. Numerous types of OCT images are mentioned in this review consisting of public retinal image datasets utilized purposefully for denoising OCT images (n = 37) and the Optic Nerve Head (ONH) (n = 4). A wide range of image quality metrics was used; PSNR and SNR that ranged between 8 and 156 dB. The minority of studies (n = 8) showed a low risk of bias in all domains. Studies utilizing ONH images produced either a PSNR or SNR value varying from 8.1 to 25.7 dB, and that of public retinal datasets was 26.4 to 158.6 dB. Further analysis on denoising models was not possible due to discrepancies in reporting that did not allow useful pooling. An increasing number of studies have investigated denoising retinal OCT images using deep learning, with a range of architectures being implemented. The reported increase in image quality metrics seems promising, while study and reporting quality are currently low.
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Affiliation(s)
- Hanya Ahmed
- Department of Electronic Engineering and Computer Science, Queen Mary University of London, London E1 4NS, UK
| | - Qianni Zhang
- Department of Electronic Engineering and Computer Science, Queen Mary University of London, London E1 4NS, UK
| | - Robert Donnan
- Department of Engineering and Materials Science, Queen Mary University of London, London E1 4NS, UK
| | - Akram Alomainy
- Department of Electronic Engineering and Computer Science, Queen Mary University of London, London E1 4NS, UK
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Elazab N, Gab-Allah WA, Elmogy M. A multi-class brain tumor grading system based on histopathological images using a hybrid YOLO and RESNET networks. Sci Rep 2024; 14:4584. [PMID: 38403597 PMCID: PMC10894864 DOI: 10.1038/s41598-024-54864-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 02/17/2024] [Indexed: 02/27/2024] Open
Abstract
Gliomas are primary brain tumors caused by glial cells. These cancers' classification and grading are crucial for prognosis and treatment planning. Deep learning (DL) can potentially improve the digital pathology investigation of brain tumors. In this paper, we developed a technique for visualizing a predictive tumor grading model on histopathology pictures to help guide doctors by emphasizing characteristics and heterogeneity in forecasts. The proposed technique is a hybrid model based on YOLOv5 and ResNet50. The function of YOLOv5 is to localize and classify the tumor in large histopathological whole slide images (WSIs). The suggested technique incorporates ResNet into the feature extraction of the YOLOv5 framework, and the detection results show that our hybrid network is effective for identifying brain tumors from histopathological images. Next, we estimate the glioma grades using the extreme gradient boosting classifier. The high-dimensional characteristics and nonlinear interactions present in histopathology images are well-handled by this classifier. DL techniques have been used in previous computer-aided diagnosis systems for brain tumor diagnosis. However, by combining the YOLOv5 and ResNet50 architectures into a hybrid model specifically designed for accurate tumor localization and predictive grading within histopathological WSIs, our study presents a new approach that advances the field. By utilizing the advantages of both models, this creative integration goes beyond traditional techniques to produce improved tumor localization accuracy and thorough feature extraction. Additionally, our method ensures stable training dynamics and strong model performance by integrating ResNet50 into the YOLOv5 framework, addressing concerns about gradient explosion. The proposed technique is tested using the cancer genome atlas dataset. During the experiments, our model outperforms the other standard ways on the same dataset. Our results indicate that the proposed hybrid model substantially impacts tumor subtype discrimination between low-grade glioma (LGG) II and LGG III. With 97.2% of accuracy, 97.8% of precision, 98.6% of sensitivity, and the Dice similarity coefficient of 97%, the proposed model performs well in classifying four grades. These results outperform current approaches for identifying LGG from high-grade glioma and provide competitive performance in classifying four categories of glioma in the literature.
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Affiliation(s)
- Naira Elazab
- Information Technology Department, Faculty of Computers and Information, Mansoura University, Mansoura, 35516, Egypt
| | - Wael A Gab-Allah
- Information Technology Department, Faculty of Computers and Information, Mansoura University, Mansoura, 35516, Egypt
| | - Mohammed Elmogy
- Information Technology Department, Faculty of Computers and Information, Mansoura University, Mansoura, 35516, Egypt.
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Cornelio A, Collazo Martinez A, Lu H, Jones C, Kashani AH. Rigid alignment method for secondary analyses of optical coherence tomography volumes. BIOMEDICAL OPTICS EXPRESS 2024; 15:938-952. [PMID: 38404338 PMCID: PMC10890897 DOI: 10.1364/boe.508123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 02/27/2024]
Abstract
Optical coherence tomography (OCT) provides micron level resolution of retinal tissue and is widely used in ophthalmology. Millions of pre-existing OCT images are available from research and clinical databases. Analysis of this data often requires or can benefit significantly from image registration and reduction of speckle noise. One method of reducing noise is to align and average multiple OCT scans together. We propose to use surface feature information and whole volume information to create a novel and simple pipeline that can rigidly align, and average multiple previously acquired 3D OCT volumes from a commercially available OCT device. This pipeline significantly improves both image quality and visualization of clinically relevant image features over single, unaligned volumes from the commercial scanner.
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Affiliation(s)
- Andrew Cornelio
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, MD 21287, USA
| | | | - Hanzhang Lu
- Department of Radiology and Radiological Science, Johns Hopkins University Hospital, Baltimore, MD 21287, USA
| | - Craig Jones
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, MD 21287, USA
- Department of Radiology and Radiological Science, Johns Hopkins University Hospital, Baltimore, MD 21287, USA
- Department of Computer Science, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Amir H Kashani
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, MD 21287, USA
- Department of Biomedical Engineering, Johns Hopkins Hospital, Baltimore, MD 21287, USA
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Li C, Zhu X, Yang K, Ju Y, Shi K, Xiao Y, Su B, Lu F, Cui L, Li M. Relationship of retinal capillary plexus and ganglion cell complex with mild cognitive impairment and dementia. Eye (Lond) 2023; 37:3743-3750. [PMID: 37270614 PMCID: PMC10698172 DOI: 10.1038/s41433-023-02592-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 05/08/2023] [Accepted: 05/17/2023] [Indexed: 06/05/2023] Open
Abstract
OBJECTIVE To investigate relationship of the retinal capillary plexus (RCP) and ganglion cell complex (GCC) with mild cognitive impairment (MCI) and dementia in a community-based study1. METHODS This cross-sectional study incorporated the participants of the Jidong Eye Cohort Study. Optical coherence tomography angiography was performed to obtain RCP vessel density and GCC thickness with detailed segments. The Mini-mental State Examination and Montreal Cognitive Assessment were used to assess cognitive status by professional neuropsychologists. Participants were thus divided into three groups: normal, mild cognitive impairment, and dementia. Multivariable analysis was used to measure relationship of ocular parameters with cognitive impairment. RESULTS Of the 2678 participants, the mean age was 44.1 ± 11.7 years. MCI and dementia occurred in 197 (7.4%) and 80 (3%) participants, respectively. Compared to the normal group, the adjusted odds ratio (OR) with the 95% confidence interval was 0.76 (0.65-0.90) for the correlation of lower deep RCP with MCI. We found the following items significantly associated with dementia compared with the normal group: a superficial (OR, 0.68 [0.54-0.86]) and deep (OR, 0.75 [0.57-0.99]) RCP, as well as the GCC (OR, 0.68 [0.54-0.85]). Compared to the MCI group, those with dementia had decreased GCC (OR, 0.75 [0.58-0.97]). CONCLUSIONS Decreased deep RCP density was associated with MCI. Decreased superficial and deep RCP and the thin GCC were correlated with dementia. These implied that the retinal microvasculature may develop into a promising non-invasive imaging marker to predict severity of cognitive impairment.
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Affiliation(s)
- Chunmei Li
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Xiaoxuan Zhu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Kai Yang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Ying Ju
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Keai Shi
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Yunfan Xiao
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Binbin Su
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Fan Lu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
| | - Lele Cui
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
| | - Ming Li
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
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Ahmed H, Zhang Q, Wong F, Donnan R, Alomainy A. Lesion Detection in Optical Coherence Tomography with Transformer-Enhanced Detector. J Imaging 2023; 9:244. [PMID: 37998091 PMCID: PMC10671998 DOI: 10.3390/jimaging9110244] [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: 09/04/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 11/25/2023] Open
Abstract
Optical coherence tomography (OCT) is an emerging imaging tool in healthcare with common applications in ophthalmology for the detection of retinal diseases and in dentistry for the early detection of tooth decay. Speckle noise is ubiquitous in OCT images, which can hinder diagnosis by clinicians. In this paper, a region-based, deep learning framework for the detection of anomalies is proposed for OCT-acquired images. The core of the framework is Transformer-Enhanced Detection (TED), which includes attention gates (AGs) to ensure focus is placed on the foreground while identifying and removing noise artifacts as anomalies. TED was designed to detect the different types of anomalies commonly present in OCT images for diagnostic purposes and thus aid clinical interpretation. Extensive quantitative evaluations were performed to measure the performance of TED against current, widely known, deep learning detection algorithms. Three different datasets were tested: two dental and one CT (hosting scans of lung nodules, livers, etc.). The results showed that the approach verifiably detected tooth decay and numerous lesions across two modalities, achieving superior performance compared to several well-known algorithms. The proposed method improved the accuracy of detection by 16-22% and the Intersection over Union (IOU) by 10% for both dentistry datasets. For the CT dataset, the performance metrics were similarly improved by 9% and 20%, respectively.
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Affiliation(s)
- Hanya Ahmed
- Department of Electronic Engineering and Computer Science, Queen Mary University of London—QMUL, London E1 4NS, UK (R.D.); (A.A.)
| | - Qianni Zhang
- Department of Electronic Engineering and Computer Science, Queen Mary University of London—QMUL, London E1 4NS, UK (R.D.); (A.A.)
| | - Ferranti Wong
- Institute of Dentistry at Barts Health, Queen Mary University of London—QMUL, London E1 4NS, UK
| | - Robert Donnan
- Department of Electronic Engineering and Computer Science, Queen Mary University of London—QMUL, London E1 4NS, UK (R.D.); (A.A.)
| | - Akram Alomainy
- Department of Electronic Engineering and Computer Science, Queen Mary University of London—QMUL, London E1 4NS, UK (R.D.); (A.A.)
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Cui T, Sun H, Hu Z, Shi Y, Zhu J, Jin M, Qin B. Optical Coherence Tomography Angiography for Evaluation of Conjunctival Vessels in Dry Eyes. J Ophthalmol 2023; 2023:1609332. [PMID: 37868692 PMCID: PMC10590264 DOI: 10.1155/2023/1609332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/22/2023] [Accepted: 09/15/2023] [Indexed: 10/24/2023] Open
Abstract
Objective This study aimed to evaluate conjunctival vessels in patients with dry eye disease (DED) using optical coherence tomography angiography (OCTA). Methods This was a cross-sectional, observational clinical study. Twenty-three eyes of 18 patients with DED and 28 eyes of 23 healthy controls were included for examination in this study. The evaluation included the application of an Ocular Surface Disease Index Questionnaire, Schirmer Basic Secretion Test, and anterior OCTA targeting the temporal conjunctiva. AngioTool software was used to quantify the total vessel length and vessel density in the 3 × 3 mm temporal region of interest. Results Blood vessel density measurements were compared across the OCTA systems. The total vessel length within the conjunctiva of the DED group (4799.34 ± 834.36) exceeded that of the control eye (3864.89 ± 1455.70) group (P < 0.05). However, the difference in vessel density between the two groups was not statistically significant. Conclusion Measurement and analysis of conjunctival blood vessels using OCTA exhibited robust repeatability. In dry eyes, the total number of conjunctival blood vessels increased in accordance with disease severity. Hypoxia of conjunctival tissue may be an important cause of dry eye disease.
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Affiliation(s)
- TongFeng Cui
- Department of Ophthalmology, Suqian First Hospital, Suqian, China
| | - HongYan Sun
- Department of Ophthalmology, Suqian First Hospital, Suqian, China
| | - ZiZhong Hu
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - YaBo Shi
- Department of Ophthalmology, Suqian First Hospital, Suqian, China
| | - Jiang Zhu
- Department of Ophthalmology, Suqian First Hospital, Suqian, China
| | - ManMan Jin
- Department of Ophthalmology, Suqian First Hospital, Suqian, China
| | - Bing Qin
- Department of Ophthalmology, Suqian First Hospital, Suqian, China
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Fasoula NA, Xie Y, Katsouli N, Reidl M, Kallmayer MA, Eckstein HH, Ntziachristos V, Hadjileontiadis L, Avgerinos DV, Briasoulis A, Siasos G, Hosseini K, Doulamis I, Kampaktsis PN, Karlas A. Clinical and Translational Imaging and Sensing of Diabetic Microangiopathy: A Narrative Review. J Cardiovasc Dev Dis 2023; 10:383. [PMID: 37754812 PMCID: PMC10531807 DOI: 10.3390/jcdd10090383] [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: 05/31/2023] [Revised: 08/21/2023] [Accepted: 08/25/2023] [Indexed: 09/28/2023] Open
Abstract
Microvascular changes in diabetes affect the function of several critical organs, such as the kidneys, heart, brain, eye, and skin, among others. The possibility of detecting such changes early enough in order to take appropriate actions renders the development of appropriate tools and techniques an imperative need. To this end, several sensing and imaging techniques have been developed or employed in the assessment of microangiopathy in patients with diabetes. Herein, we present such techniques; we provide insights into their principles of operation while discussing the characteristics that make them appropriate for such use. Finally, apart from already established techniques, we present novel ones with great translational potential, such as optoacoustic technologies, which are expected to enter clinical practice in the foreseeable future.
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Affiliation(s)
- Nikolina-Alexia Fasoula
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, 85764 Neuherberg, Germany; (N.-A.F.); (Y.X.); (N.K.); (V.N.)
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Yi Xie
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, 85764 Neuherberg, Germany; (N.-A.F.); (Y.X.); (N.K.); (V.N.)
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Nikoletta Katsouli
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, 85764 Neuherberg, Germany; (N.-A.F.); (Y.X.); (N.K.); (V.N.)
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Mario Reidl
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, 85764 Neuherberg, Germany; (N.-A.F.); (Y.X.); (N.K.); (V.N.)
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Michael A. Kallmayer
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich (TUM), 81675 Munich, Germany; (M.A.K.); (H.-H.E.)
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich (TUM), 81675 Munich, Germany; (M.A.K.); (H.-H.E.)
| | - Vasilis Ntziachristos
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, 85764 Neuherberg, Germany; (N.-A.F.); (Y.X.); (N.K.); (V.N.)
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, 81675 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, 80336 Munich, Germany
| | - Leontios Hadjileontiadis
- Department of Biomedical Engineering, Healthcare Engineering Innovation Center (HEIC), Khalifa University, Abu Dhabi P.O. Box 127788, United Arab Emirates;
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | | | - Alexandros Briasoulis
- Aleksandra Hospital, National and Kapodistrian University of Athens Medical School, 11527 Athens, Greece;
| | - Gerasimos Siasos
- Sotiria Hospital, National and Kapodistrian University of Athens Medical School, 11527 Athens, Greece;
| | - Kaveh Hosseini
- Cardiac Primary Prevention Research Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran 1411713138, Iran;
| | - Ilias Doulamis
- Department of Surgery, The Johns Hopkins Hospital, School of Medicine, Baltimore, MD 21287, USA;
| | | | - Angelos Karlas
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, 85764 Neuherberg, Germany; (N.-A.F.); (Y.X.); (N.K.); (V.N.)
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, 81675 Munich, Germany
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich (TUM), 81675 Munich, Germany; (M.A.K.); (H.-H.E.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, 80336 Munich, Germany
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Fernández-Espinosa G, Ruiz-Tabuenca C, Orduna-Hospital E, Pinilla I, Salgado-Remacha FJ. A Reliable Criterion for the Correct Delimitation of the Foveal Avascular Zone in Diabetic Patients. J Pers Med 2023; 13:jpm13050822. [PMID: 37240992 DOI: 10.3390/jpm13050822] [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: 04/09/2023] [Revised: 05/03/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Manual segmentation of the Foveal Avascular Zone (FAZ) has a high level of variability. Research into retinas needs coherent segmentation sets with low variability. METHODS Retinal optical coherence tomography angiography (OCTA) images from type-1 diabetes mellitus (DM1), type-2 diabetes mellitus (DM2) and healthy patients were included. Superficial (SCP) and deep (DCP) capillary plexus FAZs were manually segmented by different observers. After comparing the results, a new criterion was established to reduce variability in the segmentations. The FAZ area and acircularity were also studied. RESULTS The new segmentation criterion produces smaller areas (closer to the real FAZ) with lower variability than the different criteria of the explorers in both plexuses for the three groups. This was particularly noticeable for the DM2 group with damaged retinas. The acircularity values were also slightly reduced with the final criterion in all groups. The FAZ areas with lower values showed slightly higher acircularity values. We also have a consistent and coherent set of segmentations with which to continue our research. CONCLUSIONS Manual segmentations of FAZ are generally carried out with little attention to the consistency of the measurements. A novel criterion for segmenting the FAZ allows segmentations made by different observers to be more similar.
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Affiliation(s)
| | | | - Elvira Orduna-Hospital
- Aragon Institute for Health Research (IIS Aragon), 50009 Zaragoza, Spain
- Departamento de Física Aplicada, Universidad de Zaragoza, 50009 Zaragoza, Spain
| | - Isabel Pinilla
- Aragon Institute for Health Research (IIS Aragon), 50009 Zaragoza, Spain
- Department of Ophthalmology, Lozano Blesa University Hospital, 50009 Zaragoza, Spain
- Departamento de Cirugía, Universidad de Zaragoza, 50009 Zaragoza, Spain
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Melo IM, Francisconi CLM, Marafon SB, Figueiredo NA, Juncal VR, Bhambra N, Ta Kim DT, Brosh K, Berger AR, Giavedoni LR, Wong DT, Altomare F, Chow DR, Hillier RJ, Muni RH. OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY MORPHOLOGY AFTER RHEGMATOGENOUS RETINAL DETACHMENT REPAIR: ALIGN Post Hoc Analysis. Retina 2023; 43:775-783. [PMID: 36729013 DOI: 10.1097/iae.0000000000003713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To compare foveal avascular zone (FAZ) geometric indices using optical coherence tomography angiography (OCTA) in pneumatic retinopexy (PnR) versus pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD). FAZ morphology was assessed as a possible imaging feature of retinal displacement. METHODS This ALIGN post hoc analysis included primary fovea-off RRDs that underwent successful PnR or PPV, and performed OCTA, and fundus autofluorescence at (FAF) 3 months postoperatively at St. Michael's Hospital, Toronto, Canada. FAZ area (mm 2 ), axial ratio, circularity, and roundness were measured, and FAF images were assessed for retinal displacement. RESULTS Seventy-two patients were included, 78% (56/72) were male mean age was 60 ± 9 years, and 60% (43/72) were phakic. Sixty-five percent (47/72) and 35% (25/72) underwent PnR and PPV, respectively. The mean baseline logarithm of the minimum angle of resolution visual acuity was 1.49 ± 0.76. FAZ circularity was lower after PPV (0.629 ± 0.120) versus PnR (0.703 ± 0.122); P = 0.016. Sixty-six patients had gradable FAF images. Retinal displacement was present in 29% (19/66), 84.2% (16/19) of which had displacement in the macula. FAZ circularity was lower in eyes with displacement in the macula (0.613 ± 0.110) versus those without displacement (0.700 ± 0.124); P = 0.015. There was a moderate negative correlation between 12-month aniseikonia and FAZ circularity(r = -0.262; P = 0.041). CONCLUSION FAZ circularity was lower after PPV and in eyes with retinal displacement in the macula. Circularity was negatively correlated with 12-month aniseikonia scores. FAZ circularity may be another imaging feature to consider postoperatively after RRD repair.
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Affiliation(s)
- Isabela M Melo
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Carolina L M Francisconi
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Samara B Marafon
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Natalia A Figueiredo
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Verena R Juncal
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Nishaant Bhambra
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - David T Ta Kim
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Koby Brosh
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Alan R Berger
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Louis R Giavedoni
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - David T Wong
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Filiberto Altomare
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - David R Chow
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Roxane J Hillier
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom; and
| | - Rajeev H Muni
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Kensington Vision and Research Center, Toronto, Ontario, Canada
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11
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Richter GM, Lee JC, Khan N, Vorperian A, Hand B, Burkemper B, Zhou X, Chu Z, Wang R, Varma R, Kashani AH. Ocular and systemic determinants of perifoveal and macular vessel parameters in healthy African Americans. Br J Ophthalmol 2023; 107:540-546. [PMID: 34740885 DOI: 10.1136/bjophthalmol-2021-319675] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 10/18/2021] [Indexed: 01/17/2023]
Abstract
PURPOSE To determine the relationship of various systemic and ocular characteristics with perifoveal and macular vessel density in healthy African American eyes. DESIGN A population-based cross-sectional study of prospectively recruited African Americans ≥40 years of age. Participants underwent 3×3 mm and 6×6 mm macula scans using spectral-domain optical coherence tomography angiography (OCTA), clinical examinations and clinical questionnaires. Participants with glaucoma, severe non-proliferative diabetic retinopathy, proliferative diabetic retinopathy and macular oedema were excluded. Custom MATLAB based software quantified vessel area density (VAD) and vessel skeleton density (VSD) in the superficial retinal layer of the macula. Multivariable regression analysis, controlling for inter-eye correlation, was performed to determine systemic and ocular determinants of macular vessel metrics using stepwise selection. Candidate variables included: age, gender, body mass index, history of smoking, history of diabetes, diabetes duration, history of stroke or brain haemorrhage, systolic blood pressure, diastolic blood pressure (DBP), pulse pressure, mean arterial pressure, central subfield thickness (CSFT), visual field mean deviation, intraocular pressure, axial length (AL), mean ocular perfusion pressure and signal strength (SS). RESULTS A total of 2221 OCTA imaged eyes from 1472 participants were included in this study. Reduced perifoveal and macular VAD and VSD were independently associated with longer AL, reduced SS, reduced CSFT and older age. Male gender and lower DBP were also associated with reduced perifoveal and macular VSD. CONCLUSIONS When interpreting OCTA images in a clinical setting, it is important to consider the effects ocular and systemic characteristics may have on the macular microcirculation.
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Affiliation(s)
- Grace M Richter
- Ophthalmology, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Jae Chang Lee
- Ophthalmology, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Nasir Khan
- Ophthalmology, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Alexander Vorperian
- Ophthalmology, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Brennan Hand
- Ophthalmology, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Bruce Burkemper
- Ophthalmology, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Xiao Zhou
- Bioengineering, University of Washington, Seattle, Washington, USA
| | - Zhongdi Chu
- Bioengineering, University of Washington, Seattle, Washington, USA
| | - Ruikang Wang
- Bioengineering, University of Washington, Seattle, Washington, USA
| | - Rohit Varma
- Southern California Eye Institute, Los Angeles, California, USA
| | - Amir H Kashani
- Department of Ophthalmology, Johns Hopkins University, Baltimore, Maryland, USA
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12
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Remolí Sargues L, Monferrer Adsuara C, Castro Navarro V, Navarro Palop C, Montero Hernández J, Cervera Taulet E. Optical coherence tomography angiography quantitative analysis of retinal and choroidal microvasculature in patients with dyslipidemia. Eur J Ophthalmol 2022:11206721221146680. [PMID: 36562094 DOI: 10.1177/11206721221146680] [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: 12/24/2022]
Abstract
INTRODUCTION The purpose of this investigation was to report swept source-optical coherence tomography angiography (SS-OCTA) quantitative information of retinal and choroidal microvascularization in patients with dyslipidemia (DL). METHODS We performed a retrospective study. The study enrolled 37 eyes of 20 patients with DL and 40 eyes of 23 healthy subjects. OCTA quantitative parameters (vessel density (VD) and foveal avascular zone (FAZ) area of superficial capillary plexus (SCP), middle capillary plexus (MCP), deep capillary plexus (DCP) and choriocapillaris (CC)) in 6 mm × 6 mm and 4,5 mm × 4,5 mm cubes were recorded. RESULTS No differences in VD in SCP, MCP and DCP were demonstrated between DL group and control group (p > 0,05). Conversely, VD in the central region at CC was diminished in patients with DL in both cubes (p < 0,05). Moreover, total VD in CC was decreased in the DL group in 6 mm × 6 mm cube (p < 0,05). Regarding FAZ area, we demonstrated and enlargement of FAZ in each retinal capillary plexus, but it did not reach statistical significance (p > 0,05). CONCLUSION We objectified a diminution of VD in the CC, suggesting that DL mainly affects the choroidal microvasculature. Nonetheless, further studies with a larger population are needed.
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Affiliation(s)
- Lidia Remolí Sargues
- Department of Ophthalmology, 16803Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Clara Monferrer Adsuara
- Department of Ophthalmology, 16803Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Verónica Castro Navarro
- Department of Ophthalmology, 16803Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Catalina Navarro Palop
- Department of Ophthalmology, 16803Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Javier Montero Hernández
- Department of Ophthalmology, 16803Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Enrique Cervera Taulet
- Department of Ophthalmology, 16803Consorcio Hospital General Universitario of Valencia, Valencia, Spain
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Hommer N, Kallab M, Schlatter A, Howorka K, Werkmeister RM, Schmidl D, Schmetterer L, Garhöfer G. Retinal Oxygen Metabolism in Patients With Type 2 Diabetes and Different Stages of Diabetic Retinopathy. Diabetes 2022; 71:2677-2684. [PMID: 36107468 PMCID: PMC9862478 DOI: 10.2337/db22-0219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 09/11/2022] [Indexed: 02/05/2023]
Abstract
The aim of this cross-sectional study was to assess retinal oxygen metabolism in patients with type 2 diabetes and different stages of nonproliferative diabetic retinopathy (DR) (n = 67) compared with healthy control subjects (n = 20). Thirty-four patients had no DR, 15 had mild DR, and 18 had moderate to severe DR. Retinal oxygen saturation in arteries and veins was measured using the oxygen module of a retinal vessel analyzer. Total retinal blood flow (TRBF) was measured using a custom-built Doppler optical coherence tomography system. Retinal oxygen extraction was calculated from retinal oxygen saturation and TRBF. Arteriovenous difference in oxygen saturation was highest in healthy subjects (34.9 ± 7.5%), followed by patients with no DR (32.5 ± 6.3%) and moderate to severe DR (30.3 ± 6.5%). The lowest values were found in patients with mild DR (27.3 ± 8.0%, P = 0.010 vs. healthy subjects). TRBF tended to be higher in patients with no DR (40.1 ± 9.2 μL/min) and mild DR (41.8 ± 15.0 μL/min) than in healthy subjects (37.2 ± 5.7 μL/min) and patients with moderate to severe DR (34.6 ± 10.4 μL/min). Retinal oxygen extraction was the highest in healthy subjects (2.24 ± 0.57 μL O2/min), followed by patients with no DR (2.14 ± 0.6 μL O2/min), mild DR (1.90 ± 0.77 μL O2/min), and moderate to severe DR (1.78 ± 0.57 μL O2/min, P = 0.040 vs. healthy subjects). These results indicate that retinal oxygen metabolism is altered in patients with type 2 diabetes. Furthermore, retinal oxygen extraction decreases with increasing severity of DR.
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Affiliation(s)
- Nikolaus Hommer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Martin Kallab
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Andreas Schlatter
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
- Vienna Institute for Research in Ocular Surgery, Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria
| | - Kinga Howorka
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - René M. Werkmeister
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Doreen Schmidl
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Leopold Schmetterer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
- Singapore Eye Research Institute-Nanyang Technical University Advanced Ocular Engineering (STANCE), Singapore
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Gerhard Garhöfer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
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14
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Oliverio GW, Meduri A, De Salvo G, Trombetta L, Aragona P. OCT Angiography Features in Diabetes Mellitus Type 1 and 2. Diagnostics (Basel) 2022; 12:diagnostics12122942. [PMID: 36552948 PMCID: PMC9777069 DOI: 10.3390/diagnostics12122942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/16/2022] [Accepted: 11/22/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose: To study the foveal avascular zone (FAZ) and the vessel densities (VD) in diabetic patients using optical coherence tomography angiography (OCT-A) and inner retinal layer changes to compare patients affected by type 1 diabetes (DM1) and type 2 diabetes (DM2). Methods: Cross-sectional observational study involving 150 eyes of 150 patients with DM1, and 155 eyes of 155 patients with DM2 with diabetic retinopathy (DR). Retinal nerve fiber layer (RNFL) and Ganglion cell layer (GCL) were evaluated. OCT-A studied both FAZ and VD at the level of the superficial capillary plexus (SCP) and the deep capillary plexus (DCP). Results: A statistically significant difference in FAZ area and foveal VD measured at the SCP (p < 0.001) was noted between DM1 and DM2 groups when comparing patients with mild and moderate non-proliferative diabetic retinopathy (NPDR), while no differences were found in the severe NPDR and proliferative diabetic retinopathy (PDR) subgroups. Duration of diabetes and stage of DR were directly correlated with enlargement of FAZ area and inversely correlated with foveal VD measured at SCP. RNFL and GCL were not different between DM1 and DM2 groups. Conclusion: Changes in OCT-A parameters detected in FAZ area and VD of diabetic patients with different stages of DR may help to predict the risk for progression of the disease.
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Affiliation(s)
| | - Alessandro Meduri
- Department of Biomedical Science, Ophthalmology Clinic, University of Messina, 98124 Messina, Italy
- Correspondence: ; Tel.: +39-09022173
| | - Gabriella De Salvo
- Ophthalmology Department, University Hospital Southampton, Southampton SO16 5YA, UK
| | - Luigi Trombetta
- Department of Biomedical Science, Ophthalmology Clinic, University of Messina, 98124 Messina, Italy
| | - Pasquale Aragona
- Department of Biomedical Science, Ophthalmology Clinic, University of Messina, 98124 Messina, Italy
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15
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Hommer N, Kallab M, Schlatter A, Janku P, Werkmeister RM, Howorka K, Schmidl D, Schmetterer L, Garhöfer G. Neuro-vascular coupling and heart rate variability in patients with type II diabetes at different stages of diabetic retinopathy. Front Med (Lausanne) 2022; 9:1025853. [PMID: 36438055 PMCID: PMC9684184 DOI: 10.3389/fmed.2022.1025853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022] Open
Abstract
Aims/Hypothesis There is evidence that diabetes is accompanied by a break-down of functional hyperemia, an intrinsic mechanism of neural tissues to adapt blood flow to changing metabolic demands. However, to what extent functional hyperemia is altered in different stages of diabetic retinopathy (DR) in patients with type II diabetes is largely unknown. The current study set out to investigate flicker-induced retinal blood flow changes in patients with type II diabetes at different stages of DR. Materials and methods A total of 76 subjects were included in the present parallel-group study, of which 56 had diabetes with either no DR or different stages of non-proliferative DR (n = 29 no DR, 12 mild DR, 15 moderate to severe DR). In addition, 20 healthy subjects were included as controls. Retinal blood flow was assessed before and during visual stimulation using a combined measurement of retinal vessel calibers and blood velocity by the means of Doppler optical coherence tomography (OCT). To measure systemic autonomic nervous system function, heart rate variability (HRV) was assessed using a short-term orthostatic challenge test. Results In healthy controls, retinal blood flow increased by 40.4 ± 27.2% during flicker stimulation. Flicker responses in patients with DR were significantly decreased depending on the stage of the disease (no DR 37.7 ± 26.0%, mild DR 26.2 ± 28.2%, moderate to severe DR 22.3 ± 13.9%; p = 0.035, ANOVA). When assessing systemic autonomous neural function using HRV, normalized low frequency (LF) spectral power showed a significantly different response to the orthostatic maneuver in diabetic patients compared to healthy controls (p < 0.001). Conclusion/Interpretation Our study indicates that flicker induced hyperemia is reduced in patients with DR compared to healthy subjects. Further, this impairment is more pronounced with increasing severity of DR. Further studies are needed to elucidate mechanisms behind the reduced hyperemic response in patients with type II diabetes. Clinical trial registration [https://clinicaltrials.gov/], identifier [NCT03 552562].
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Affiliation(s)
- Nikolaus Hommer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Martin Kallab
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Andreas Schlatter
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
- Hanusch Hospital, Karl Landsteiner Institute, Vienna, Austria
- Hanusch Hospital, Vienna Institute for Research in Ocular Surgery, Vienna, Austria
| | - Patrick Janku
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - René M. Werkmeister
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Kinga Howorka
- Metabolic Competence Center, Medical University of Vienna, Vienna, Austria
| | - Doreen Schmidl
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Leopold Schmetterer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore, Singapore
- Institute of Clinical and Experimental Ophthalmology, Basel, Switzerland
| | - Gerhard Garhöfer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
- *Correspondence: Gerhard Garhöfer,
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16
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Su B, Zhu X, Yang K, Xiao Y, Li C, Shi K, Qu J, Lu F, Li M, Cui L. Age- and sex-related differences in the retinal capillary plexus in healthy Chinese adults. EYE AND VISION 2022; 9:38. [PMID: 36180939 PMCID: PMC9526290 DOI: 10.1186/s40662-022-00307-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/24/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND To assess age- and sex-related changes in the superficial retinal capillary plexus (SCP) and deep retinal capillary plexus (DCP) in healthy Chinese adults. METHODS In this cross-sectional study, all data were derived from the community-based Jidong Eye Cohort Study. Participants underwent optical coherence tomography angiography (OCTA) and other ocular and systemic examinations. The vessel densities of the whole measured area, parafovea, and four quadrants in the SCP and DCP were measured. RESULTS We recruited 1036 eyes of 1036 healthy participants; the mean age was 40.4 ± 9.8 years, and 449 (43.3%) participants were males. The SCP and DCP vessel densities in all regions, except for temporal and nasal regions in the SCP, non-linearly decreased with age. The DCP vessel densities began to decrease at approximately 35 years of age, while the SCP vessel densities began to decrease at approximately 40 years of age. The DCP vessel densities decreased more rapidly than the SCP vessel densities at 35-50 years of age. The DCP vessel densities remained stable or slightly decreased after the age of 50 years in females, while those decreased linearly in most regions in males. CONCLUSIONS The retinal vessel density decreased earlier and more rapidly in the DCP than in the SCP, and the effect of aging on the DCP vessel density was sex-dependent. Our findings suggest that age and sex should be considered when interpreting clinical quantitative OCTA data.
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Affiliation(s)
- Binbin Su
- grid.414701.7Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang 325003 People’s Republic of China
| | - Xiaoxuan Zhu
- grid.414701.7Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang 325003 People’s Republic of China
| | - Kai Yang
- grid.414701.7Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang 325003 People’s Republic of China
| | - Yunfan Xiao
- grid.414701.7Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang 325003 People’s Republic of China
| | - Chunmei Li
- grid.414701.7Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang 325003 People’s Republic of China
| | - Keai Shi
- grid.414701.7Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang 325003 People’s Republic of China
| | - Jia Qu
- grid.414701.7Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang 325003 People’s Republic of China
| | - Fan Lu
- grid.414701.7Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang 325003 People’s Republic of China
| | - Ming Li
- grid.414701.7Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang 325003 People’s Republic of China
| | - Lele Cui
- grid.414701.7Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang 325003 People’s Republic of China
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17
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Scheive M, Reinhart KL, Hajrasouliha AR. Using optical coherence tomography angiography as a biomarker of retinopathy severity and treatment for diabetic retinopathy. Mol Vis 2022; 28:220-229. [PMID: 36284673 PMCID: PMC9514547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 08/17/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose The goal was to evaluate optical coherence tomography angiography (OCT-A) as a biomarker to correlate retinal vessel density (VD) with diabetic retinopathy (DR) severity and visual acuity, as well as track antivascular endothelial growth factor (VEGF) treatment efficacy. Methods This retrospective cohort study analyzed the automatically quantified VDs of the superficial vascular complex (SVC) and deep vascular complex (DVC), including the whole, foveal, and parafoveal VDs, on quality OCT-A scans in patients diagnosed with DR. A multivariate linear regression and analysis of variance (ANOVA) analysis compared VDs to DR severity, visual acuity, and demographic factors. A linear mixed analysis determined the effects of VD by whether anti-VEGF therapy was given to patients with OCT-A scans at multiple time points. Results There was a positive correlation of the VDs in both the SVC whole and parafoveal VD and DVC parafoveal VD with decreased DR severity and increased visual acuity (p≤0.001). The DVC whole VD was also positively correlated with increased visual acuity (p<0.001). There was no difference in the VDs associated with anti-VEGF treatment over time. Conclusions OCT-A VD shows promise for diagnosing and monitoring DR using DR severity and visual acuity. Anti-VEGF treatment had no significant effect (p=0.063) on vascular density in diabetic retinopathy.
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Affiliation(s)
| | | | - Amir R. Hajrasouliha
- Indiana University School of Medicine, Indianapolis, IN,Glick Eye Institute. Department of Ophthalmology, Indiana University, Indianapolis, IN
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Chong V, Nguyen QD, Sepah Y, Giani A, Pearce E. HORNBILL: a phase I/IIa trial examining the safety, tolerability and early response of BI 764524 in patients with diabetic retinopathy and diabetic macular ischaemia-rationale, study design and protocol. Trials 2022; 23:669. [PMID: 35978329 PMCID: PMC9386971 DOI: 10.1186/s13063-022-06527-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 07/06/2022] [Indexed: 11/23/2022] Open
Abstract
Background Diabetic macular ischaemia (DMI) is a complication of diabetic retinopathy that leads to irreversible vision loss. DMI is characterised by reduced retinal vessel density and enlargement of the foveal avascular zone (FAZ). Despite its clinical burden, there is no formal consensus on the definition of DMI, and no approved treatment. Semaphorin 3A (Sema3A) is an axonal guidance molecule that blocks revascularisation of the ischaemic retina. Sema3A modulation is therefore a promising mechanism of action for the treatment of ischaemic eye diseases. BI 764524 is an intravitreal anti-Sema3A ischaemia modulator agent. Methods HORNBILL (NCT04424290) is a phase I/IIa trial comprising a non-randomised, open-label, single rising dose (SRD) part and a randomised, masked, sham-controlled multiple dose (MD) part to investigate the safety, tolerability and early biological response of ischaemia modulator BI 764524 in adults (≥18 years) with DMI. DMI will be defined using optical coherence tomography angiography (OCTA) as either any degree of disruption in the retinal vascularity (SRD) or a FAZ of ≥0.5 mm2 (MD). Subjects in the SRD part will receive 0.5, 1.0 or 2.5 mg of BI 764524; the maximum tolerated dose will then be used in the MD part. A minimum of 12 subjects will be enrolled into the SRD part; planned enrollment is 30 for the MD part. The primary endpoint of the SRD part is the number of subjects with dose-limiting adverse events (AEs) until day 8. The primary endpoint of the MD part is the number of subjects with drug-related AEs from baseline to end of study, and secondary endpoints include change from baseline in the size of the FAZ, best-corrected visual acuity and central retinal thickness. Discussion DMI is a poorly defined condition with no treatment options. HORNBILL is the first clinical trial to assess a treatment for DMI and to use OCTA as a means to define and examine DMI. The OCTA data generated in this trial could form the basis of formal diagnostic criteria for DMI. Furthermore, the novel mechanism of action (Sema3A modulation) explored in this trial has the potential to revolutionise the treatment landscape for patients with DMI. Trial registration ClinicalTrials.govNCT04424290; EudraCT 2019-004432-28. Registered on 9 June 2020 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06527-y.
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Affiliation(s)
- Victor Chong
- UCL Institute of Ophthalmology, University College London, London, UK.
| | - Quan Dong Nguyen
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Yasir Sepah
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Andrea Giani
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
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Bianco L, Arrigo A, Aragona E, Antropoli A, Berni A, Saladino A, Battaglia Parodi M, Bandello F. Neuroinflammation and neurodegeneration in diabetic retinopathy. Front Aging Neurosci 2022; 14:937999. [PMID: 36051309 PMCID: PMC9424735 DOI: 10.3389/fnagi.2022.937999] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/28/2022] [Indexed: 11/30/2022] Open
Abstract
Diabetic retinopathy (DR) is the most common complication of diabetes and has been historically regarded as a microangiopathic disease. Now, the paradigm is shifting toward a more comprehensive view of diabetic retinal disease (DRD) as a tissue-specific neurovascular complication, in which persistently high glycemia causes not only microvascular damage and ischemia but also intraretinal inflammation and neuronal degeneration. Despite the increasing knowledge on the pathogenic pathways involved in DR, currently approved treatments are focused only on its late-stage vasculopathic complications, and a single molecular target, vascular endothelial growth factor (VEGF), has been extensively studied, leading to drug development and approval. In this review, we discuss the state of the art of research on neuroinflammation and neurodegeneration in diabetes, with a focus on pathophysiological studies on human subjects, in vivo imaging biomarkers, and clinical trials on novel therapeutic options.
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Affiliation(s)
| | - Alessandro Arrigo
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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20
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Goldberg RA, Hill L, Davis T, Stoilov I. Effect of less aggressive treatment on diabetic retinopathy severity scale scores: analyses of the RIDE and RISE open-label extension. BMJ Open Ophthalmol 2022; 7:bmjophth-2022-001007. [PMID: 36161830 PMCID: PMC9341173 DOI: 10.1136/bmjophth-2022-001007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/01/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate factors associated with Diabetic Retinopathy Severity Scale (DRSS) changes with less frequent ranibizumab after induction therapy. Methods and analysis Post hoc analyses of RIDE/RISE and their open-label extension (OLE). Analyses included patients with diabetic retinopathy (DR)/diabetic macular oedema who completed the OLE. Comparisons were made between patients with improved/maintained (≥0 step decrease from OLE baseline (month 36) to month 48) versus worsened (≥1 step increase) DRSS during the OLE. DRSS changes over 12 months were compared between patients randomised to ranibizumab at RIDE/RISE baseline who improved to DRSS score ≤43 at OLE baseline (induced) versus those randomised to sham with DRSS score ≤43 at RIDE/RISE baseline (native). Results From OLE baseline to month 48, 72% (263/367) of patients improved/maintained DRSS scores. These patients had similar mean best-corrected visual acuity at RIDE/RISE (56.4 letters) and OLE baseline (68.6 letters) versus patients with worsened scores (58.2 and 70.8 letters). Patients who improved/maintained DRSS scores had similar mean central foveal thickness at RIDE/RISE (492 µm) and OLE baseline (196 µm) versus patients with worsened scores (441 and 167 µm). Patients who improved/maintained DRSS scores received a significantly higher (p<0.0001) mean number of pro re nata (PRN) injections (4.4) between OLE baseline and month 48 versus those with worsened scores (2.3). Patients with more severe DR at baseline who achieved mild-to-moderate non-proliferative DR (NPDR) induced by monthly ranibizumab injections were significantly more likely to worsen (p<0.0001) than those with mild-to-moderate NPDR at baseline randomised to sham injections (1.0-step versus 0.1-step worsening). Conclusions Most patients improved/maintained DRSS scores with less-than-monthly PRN ranibizumab. Some minimum treatment/monitoring may be necessary to maintain improvements after induction therapy. Trial registration numbers NCT00473382/NCT00473330.
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Affiliation(s)
| | - Lauren Hill
- Genentech Inc, South San Francisco, California, USA
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21
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A computer-aided diagnosis system for detecting various diabetic retinopathy grades based on a hybrid deep learning technique. Med Biol Eng Comput 2022; 60:2015-2038. [PMID: 35545738 PMCID: PMC9225981 DOI: 10.1007/s11517-022-02564-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 03/25/2022] [Indexed: 12/23/2022]
Abstract
Diabetic retinopathy (DR) is a serious disease that may cause vision loss unawares without any alarm. Therefore, it is essential to scan and audit the DR progress continuously. In this respect, deep learning techniques achieved great success in medical image analysis. Deep convolution neural network (CNN) architectures are widely used in multi-label (ML) classification. It helps in diagnosing normal and various DR grades: mild, moderate, and severe non-proliferative DR (NPDR) and proliferative DR (PDR). DR grades are formulated by appearing multiple DR lesions simultaneously on the color retinal fundus images. Many lesion types have various features that are difficult to segment and distinguished by utilizing conventional and hand-crafted methods. Therefore, the practical solution is to utilize an effective CNN model. In this paper, we present a novel hybrid, deep learning technique, which is called E-DenseNet. We integrated EyeNet and DenseNet models based on transfer learning. We customized the traditional EyeNet by inserting the dense blocks and optimized the resulting hybrid E-DensNet model's hyperparameters. The proposed system based on the E-DenseNet model can accurately diagnose healthy and different DR grades from various small and large ML color fundus images. We trained and tested our model on four different datasets that were published from 2006 to 2019. The proposed system achieved an average accuracy (ACC), sensitivity (SEN), specificity (SPE), Dice similarity coefficient (DSC), the quadratic Kappa score (QKS), and the calculation time (T) in minutes (m) equal [Formula: see text], [Formula: see text], [Formula: see text], [Formula: see text], 0.883, and 3.5m respectively. The experiments show promising results as compared with other systems.
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22
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Chen Z, Xiong Y, Wei H, Zhao R, Duan X, Shen H. Dual-consistency semi-supervision combined with self-supervision for vessel segmentation in retinal OCTA images. BIOMEDICAL OPTICS EXPRESS 2022; 13:2824-2834. [PMID: 35774329 PMCID: PMC9203111 DOI: 10.1364/boe.458004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/04/2022] [Accepted: 04/12/2022] [Indexed: 06/15/2023]
Abstract
Optical coherence tomography angiography(OCTA) is an advanced noninvasive vascular imaging technique that has important implications in many vision-related diseases. The automatic segmentation of retinal vessels in OCTA is understudied, and the existing segmentation methods require large-scale pixel-level annotated images. However, manually annotating labels is time-consuming and labor-intensive. Therefore, we propose a dual-consistency semi-supervised segmentation network incorporating multi-scale self-supervised puzzle subtasks(DCSS-Net) to tackle the challenge of limited annotations. First, we adopt a novel self-supervised task in assisting semi-supervised networks in training to learn better feature representations. Second, we propose a dual-consistency regularization strategy that imposed data-based and feature-based perturbation to effectively utilize a large number of unlabeled data, alleviate the overfitting of the model, and generate more accurate segmentation predictions. Experimental results on two OCTA retina datasets validate the effectiveness of our DCSS-Net. With very little labeled data, the performance of our method is comparable with fully supervised methods trained on the entire labeled dataset.
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Affiliation(s)
- Zailiang Chen
- School of Information Science and Engineering, Central South University, Changsha 410083, China
| | - Yuchen Xiong
- School of Information Science and Engineering, Central South University, Changsha 410083, China
| | - Hao Wei
- School of Information Science and Engineering, Central South University, Changsha 410083, China
| | - Rongchang Zhao
- School of Information Science and Engineering, Central South University, Changsha 410083, China
| | - Xuanchu Duan
- Changsha Aier Eye Hospital, Changsha 410015, China
| | - Hailan Shen
- School of Information Science and Engineering, Central South University, Changsha 410083, China
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Zhu X, Yang K, Xiao Y, Ye C, Zheng J, Su B, Zheng Y, Zhang X, Shi K, Li C, Lu F, Qu J, Li M, Cui L. Association of cigarette smoking with retinal capillary plexus: an optical coherence tomography angiography study. Acta Ophthalmol 2022; 100:e1479-e1488. [PMID: 35396902 DOI: 10.1111/aos.15157] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/18/2022] [Accepted: 03/30/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the association between cigarette smoking and retinal capillary plexus (RCP) using optical coherence tomography angiography (OCTA) and to examine whether potential vascular risk factors could impact their association. METHODS This is a cross-sectional, community-based study. The Jidong Eye Cohort Study included participants aged ≥18 years in the Jidong community (Tangshan city, northern China) from August 2019 to January 2020. All participants underwent comprehensive ophthalmic examination and completed detailed smoking questionnaires. Retinal vessel density in the superficial and deep RCP was automatically measured using OCTA. RESULTS Of the 2598 participants included in the study, 2026 (78.0%) never smoked and 572 (22.0%) had a history of smoking (494 [19.0%] current smokers and 78 [3.0%] former smokers). The median (interquartile range) age was 41 (34-52) years for the non-smoking group and 45 (35-54.5) years for the smoking group. Multivariable analysis showed that smoking history is associated with a low deep RCP vessel density in the parafovea (β, -0.53; 95% confidence interval [CI], -0.82 to -0.24) and four quadrants. Increased smoking pack-years were associated with reduced deep RCP vessel density in the parafovea (p for trend <0.001) and four quadrants. The significant interaction between diabetes and smoking only was found for superficial RCP vessel density in the parafovea (p for interaction = 0.014) and four quadrants except for the temporal quadrants. CONCLUSIONS Cigarette smoking is an independent risk factor for reduced deep RCP vessel density. Our findings imply the potential detrimental effect of smoking on the occurrence of ocular diseases.
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Affiliation(s)
- Xiaoxuan Zhu
- Eye Hospital and School of Ophthalmology and Optometry, National Clinical Research Center for Ocular Diseases Wenzhou Medical University Wenzhou China
| | - Kai Yang
- Eye Hospital and School of Ophthalmology and Optometry, National Clinical Research Center for Ocular Diseases Wenzhou Medical University Wenzhou China
| | - Yunfan Xiao
- Eye Hospital and School of Ophthalmology and Optometry, National Clinical Research Center for Ocular Diseases Wenzhou Medical University Wenzhou China
| | - Cong Ye
- Eye Hospital and School of Ophthalmology and Optometry, National Clinical Research Center for Ocular Diseases Wenzhou Medical University Wenzhou China
| | - Jingwei Zheng
- Eye Hospital and School of Ophthalmology and Optometry, National Clinical Research Center for Ocular Diseases Wenzhou Medical University Wenzhou China
| | - Binbin Su
- Eye Hospital and School of Ophthalmology and Optometry, National Clinical Research Center for Ocular Diseases Wenzhou Medical University Wenzhou China
| | - Yang Zheng
- Eye Hospital and School of Ophthalmology and Optometry, National Clinical Research Center for Ocular Diseases Wenzhou Medical University Wenzhou China
| | - Xinyao Zhang
- Eye Hospital and School of Ophthalmology and Optometry, National Clinical Research Center for Ocular Diseases Wenzhou Medical University Wenzhou China
| | - Keai Shi
- Eye Hospital and School of Ophthalmology and Optometry, National Clinical Research Center for Ocular Diseases Wenzhou Medical University Wenzhou China
| | - Chunmei Li
- Eye Hospital and School of Ophthalmology and Optometry, National Clinical Research Center for Ocular Diseases Wenzhou Medical University Wenzhou China
| | - Fan Lu
- Eye Hospital and School of Ophthalmology and Optometry, National Clinical Research Center for Ocular Diseases Wenzhou Medical University Wenzhou China
| | - Jia Qu
- Eye Hospital and School of Ophthalmology and Optometry, National Clinical Research Center for Ocular Diseases Wenzhou Medical University Wenzhou China
| | - Ming Li
- Eye Hospital and School of Ophthalmology and Optometry, National Clinical Research Center for Ocular Diseases Wenzhou Medical University Wenzhou China
| | - Lele Cui
- Eye Hospital and School of Ophthalmology and Optometry, National Clinical Research Center for Ocular Diseases Wenzhou Medical University Wenzhou China
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Yasser I, Khalifa F, Abdeltawab H, Ghazal M, Sandhu HS, El-Baz A. Automated Diagnosis of Optical Coherence Tomography Angiography (OCTA) Based on Machine Learning Techniques. SENSORS 2022; 22:s22062342. [PMID: 35336513 PMCID: PMC8952189 DOI: 10.3390/s22062342] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 12/17/2022]
Abstract
Diabetic retinopathy (DR) refers to the ophthalmological complications of diabetes mellitus. It is primarily a disease of the retinal vasculature that can lead to vision loss. Optical coherence tomography angiography (OCTA) demonstrates the ability to detect the changes in the retinal vascular system, which can help in the early detection of DR. In this paper, we describe a novel framework that can detect DR from OCTA based on capturing the appearance and morphological markers of the retinal vascular system. This new framework consists of the following main steps: (1) extracting retinal vascular system from OCTA images based on using joint Markov-Gibbs Random Field (MGRF) model to model the appearance of OCTA images and (2) estimating the distance map inside the extracted vascular system to be used as imaging markers that describe the morphology of the retinal vascular (RV) system. The OCTA images, extracted vascular system, and the RV-estimated distance map is then composed into a three-dimensional matrix to be used as an input to a convolutional neural network (CNN). The main motivation for using this data representation is that it combines the low-level data as well as high-level processed data to allow the CNN to capture significant features to increase its ability to distinguish DR from the normal retina. This has been applied on multi-scale levels to include the original full dimension images as well as sub-images extracted from the original OCTA images. The proposed approach was tested on in-vivo data using about 91 patients, which were qualitatively graded by retinal experts. In addition, it was quantitatively validated using datasets based on three metrics: sensitivity, specificity, and overall accuracy. Results showed the capability of the proposed approach, outperforming the current deep learning as well as features-based detecting DR approaches.
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Affiliation(s)
- Ibrahim Yasser
- Faculty of Engineering, Mansoura University, Mansoura 35516, Egypt;
| | - Fahmi Khalifa
- Department of Bioengineering, University of Louisville, Louisville, KY 40292, USA; (F.K.); (H.A.); (H.S.S.)
| | - Hisham Abdeltawab
- Department of Bioengineering, University of Louisville, Louisville, KY 40292, USA; (F.K.); (H.A.); (H.S.S.)
| | - Mohammed Ghazal
- Electrical and Computer Engineering Department, Abu Dhabi University, Abu Dhabi P.O. Box 59911, United Arab Emirates;
| | - Harpal Singh Sandhu
- Department of Bioengineering, University of Louisville, Louisville, KY 40292, USA; (F.K.); (H.A.); (H.S.S.)
| | - Ayman El-Baz
- Department of Bioengineering, University of Louisville, Louisville, KY 40292, USA; (F.K.); (H.A.); (H.S.S.)
- Correspondence:
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Recommendations for OCT Angiography Reporting in Retinal Vascular Disease: A Delphi Approach by International Experts. Ophthalmol Retina 2022; 6:753-761. [PMID: 35202889 PMCID: PMC9393205 DOI: 10.1016/j.oret.2022.02.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 02/12/2022] [Accepted: 02/15/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE To develop a consensus nomenclature for reporting OCT angiography (OCTA) findings in retinal vascular disease (e.g., diabetic retinopathy, retinal vein occlusion) by international experts. DESIGN Delphi-based survey. SUBJECTS, PARTICIPANTS, AND/OR CONTROLS Twenty-five retinal vascular disease and OCTA imaging experts. METHODS, INTERVENTION, OR TESTING A Delphi method of consensus development was used, comprising 2 rounds of online questionnaires, followed by a face-to-face meeting conducted virtually. Twenty-five experts in retinal vascular disease and retinal OCTA imaging were selected to constitute the OCTA Nomenclature in Delphi Study Group for retinal vascular disease. The 4 main areas of consensus were: definition of the parameters of "wide-field (WF)" OCTA, measurement of decreased vascular flow on conventional and WF-OCTA, nomenclature of OCTA findings, and OCTA in retinal vascular disease management and staging. The study end point was defined by the degree of consensus for each question: "strong consensus" was defined as ≥85% agreement, "consensus" as 80% to 84%, and "near consensus" as 70% to 79%. MAIN OUTCOME MEASURES Consensus and near consensus on OCTA nomenclature in retinal vascular disease. RESULTS A consensus was reached that a meaningful change in percentage of flow on WF-OCTA imaging should be an increase or decrease ≥30% of the absolute imaged area of flow signal and that a "large area" of WF-OCTA reduced flow signal should also be defined as ≥30% of the absolute imaged area. The presence of new vessels and intraretinal microvascular abnormalities, the foveal avascular zone parameters, the presence and amount of "no-flow areas," and the assessment of vessel density in various retinal layers should be added for the staging and classification of diabetic retinopathy. Decreased flow ≥30% of the absolute imaged area should define an ischemic central retinal vein occlusion. Several other items did not meet consensus requirements or were rejected in the final discussion round. CONCLUSIONS This study provides international consensus recommendations for reporting OCTA findings in retinal vascular disease, which may help to improve the interpretability and description in clinic and clinical trials. Further validation in these settings is warranted and ongoing. Efforts are continuing to address unresolved questions.
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Retinal Vascularization Abnormalities Studied by Optical Coherence Tomography Angiography (OCTA) in Type 2 Diabetic Patients with Moderate Diabetic Retinopathy. Diagnostics (Basel) 2022; 12:diagnostics12020379. [PMID: 35204470 PMCID: PMC8871460 DOI: 10.3390/diagnostics12020379] [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: 12/24/2021] [Revised: 01/18/2022] [Accepted: 01/29/2022] [Indexed: 11/17/2022] Open
Abstract
Diabetic retinopathy (DR) is the most severe and frequent retinal vascular disease that causes significant visual loss on a global scale. The purpose of our study was to evaluate retinal vascularization in the superficial capillary plexus (SCP), the deep capillary plexus (DCP) and the choriocapillaris (CC) and changes in the foveal avascular zone (FAZ) by optical tomography angiography (OCTA) in patients with type 2 diabetes mellitus (DM2) with moderate DR but without diabetic macular oedema (DME). Fifty-four eyes of DM2 with moderate DR (level 43 in the ETDRS scale) and without DME and 73 age-matched healthy eyes were evaluated using OCTA with swept-source (SS)-OCT to measure microvascularization changes in SCP, DCP, CC and the FAZ. The mean ages were 64.06 ± 11.98 and 60.79 ± 8.62 years in the DM2 and control groups, respectively. Visual acuity (VA) was lower in the DM2 patients (p = 0.001), OCTA showed changes in the SCP with a significant diminution in the vascular density and the FAZ area was significantly higher compared to healthy controls, with p < 0.001 at the SCP level. The most prevalent anatomical alterations were peripheral disruption in the SCP (83.3%), microaneurysms (MA) in the SCP and in the DCP (79.6% and 79.6%, respectively) and flow changes in the DCP (81.5%). A significant positive correlation was observed between the DM2 duration and the FAZ area in the SCP (0.304 with p = 0.025). A significant negative correlation was also found between age and CC central perfusion (p < 0.001). In summary, a decrease in the vascular density in DM2 patients with moderate DR without DME was observed, especially at the retinal SPC level. Furthermore, it was found that the FAZ was increased in the DM2 group in both retinal plexuses and was greater in the SCP group.
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Memon AS, Memon NA, Mahar PS. Role of Optical Coherence Tomography Angiography to differentiate Intraretinal microvascular abnormalities and retinal neovascularization in Diabetic Retinopathy. Pak J Med Sci 2022; 38:57-61. [PMID: 35035401 PMCID: PMC8713212 DOI: 10.12669/pjms.38.1.3891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 12/08/2020] [Accepted: 07/29/2021] [Indexed: 11/15/2022] Open
Abstract
Objective To assess proliferative diabetic retinopathy (PDR) and to describe the difference in angiographic representation of new vessels (NVs) and Intra retinal microvascular abnormalities (IRMA) on optical coherence tomography angiography (OCTA). Methods A cross-sectional observational study was performed at ISRA Postgraduate Institute of Ophthalmology, Karachi, from March 2018 to September 2018. Forty-two eyes of 21 patients with history of diabetes mellitus (DM) were examined. Twenty-eight eyes with a clinical diagnosis of severe non proliferative diabetic retinopathy (NPDR) or proliferative diabetic retinopathy (PDR) according to early treatment diabetic retinopathy study (ETDRS) were included and evaluated using Swept source optical coherence tomography angiography (SS-OCTA). Then face wide field SS-OCTA images and co registered structural optical coherence tomography (OCT) with flow overlay were used to distinguish the features of IRMA and retinal NVs. Results Forty-two eyes (21 patients) were examined clinically. Fourteen eyes had moderate NPDR, 15 had severe NPDR and 13 eyes had changes consistent with PDR. After clinical diagnosis, we included 28 eyes in our study based on inclusion criteria. These 28 eyes went through SS-OCTA evaluation and we observed 15 cases with PDR and 13 with severe NPDR changes. The OCTA and clinical diagnosis were similar except in 2 eyes, which is critical but not statically significant showing the importance of this noninvasive technology. Conclusions Widefield OCTA can work as an alternative to fundus fluorescein angiography (FFA) in the diagnosis of diabetic retinopathy (DR). As it is a non-invasive and depth encoded technique so can be used frequently to monitor the retinal changes and their progression.
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Affiliation(s)
- A Sami Memon
- Dr. Abdul Sami Memon, FCPS. Assistant Professor, Aga Khan University Hospital, Karachi, Pakistan. Isra Postgraduate Institute of Ophthalmology, Karachi, Pakistan
| | - Nasir A Memon
- Dr. Nasir Ahmed Memon, FCPS. Assistant Professor, Isra Postgraduate Institute of Ophthalmology, Karachi, Pakistan
| | - Pir Salim Mahar
- Prof. Dr. P.S. Mahar, FRCS, FRCOphth. Professor of Ophthalmology, Aga Khan University Hospital, Karachi, Pakistan. Isra Postgraduate Institute of Ophthalmology, Karachi, Pakistan
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Baltă F, Cristescu IE, Mirescu AE, Baltă G, Zemba M, Tofolean IT. Investigation of Retinal Microcirculation in Diabetic Patients Using Adaptive Optics Ophthalmoscopy and Optical Coherence Angiography. J Diabetes Res 2022; 2022:1516668. [PMID: 35097129 PMCID: PMC8791707 DOI: 10.1155/2022/1516668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/21/2021] [Accepted: 01/03/2022] [Indexed: 01/08/2023] Open
Abstract
The current research approaches the retinal microvasculature of healthy volunteers (17 subjects), patients with diabetes mellitus without retinopathy (19 subjects), and of diabetic patients with nonproliferative (17 subjects) and proliferative (21 subjects) diabetic retinopathy, by using adaptive optics ophthalmoscopy and optical coherence ophthalmoscopy angiography. For each imaging technique, several vascular parameters have been calculated in order to achieve a comparative analysis of these imaging biomarkers between the four studied groups. The results suggest that diabetic patients with or without diabetic retinopathy prove signs of retinal arteriole structural alterations, mainly showed by altered values of wall to lumen ratio, calculated for the superior or inferior temporal branch of the central retinal artery, near the optic nerve head, and significant changes of the vascular density in the retinal superficial capillary plexus. Both adaptive optics ophthalmoscopy and optical coherence ophthalmoscopy angiography are providing useful information about the retinal microvasculature from early onset of diabetic disease, having a promising diagnostic and prognostic role in the future.
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Affiliation(s)
- Florian Baltă
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Clinical Emergency Eye Hospital, 030167 Bucharest, Romania
- “Retina” Clinic, 014142 Bucharest, Romania
| | - Irina-Elena Cristescu
- “Retina” Clinic, 014142 Bucharest, Romania
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Andrada-Elena Mirescu
- Clinical Emergency Eye Hospital, 030167 Bucharest, Romania
- Department of Ophthalmology, “Ovidius” University of Medicine, 900470 Constanta, Romania
| | - George Baltă
- Clinical Emergency Eye Hospital, 030167 Bucharest, Romania
| | - Mihail Zemba
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Ophthalmology, “Dr. Carol Davila” Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Ioana Teodora Tofolean
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- “Retina” Clinic, 014142 Bucharest, Romania
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Hunt M, Teper S, Wylęgała A, Wylęgała E. Response to 1-Year Fixed-Regimen Bevacizumab Therapy in Treatment-Naïve DME Patients: Assessment by OCT Angiography. J Diabetes Res 2022; 2022:3547461. [PMID: 35237693 PMCID: PMC8885291 DOI: 10.1155/2022/3547461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/13/2022] [Accepted: 02/01/2022] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To evaluate the effectiveness of intravitreal bevacizumab treatment in patients with diabetic macular edema (DME) by assessing retinal changes using optical coherence tomography angiography (OCT-A). METHODS This prospective study was performed in patients with treatment-naïve DME. The eyes of patients were imaged using a swept-source OCT system with a scan area of 6 × 6 mm. The DME patients with a central macular thickness (CMT) of ≥300 μm received nine bevacizumab injections within 12 months. The demographic, systemic, and ocular parameters, including the best-corrected visual acuity (BCVA), CMT, microaneurysm (MA) count, and foveal avascular zone (FAZ) area in both superficial capillary plexus (SCP) and deep capillary plexus (DCP), as well as vessel density in SCP, were assessed in the patients. In addition, the response (good or poor) of the DME eyes to bevacizumab treatment and the final visual acuity (BCVA of 75 letters) were analyzed. RESULTS Seventy-seven eyes of DME patients were subjected to the final analysis. Bevacizumab treatment reduced CMT from 425.06 μm (±77.15) to 350.25 μm (±82.04) and improved BCVA by about 8.61 letters (from 64.73 to 73.34) in the patients. The mean number of MAs in SCP decreased from 3.51 ± 2.07 to 2.31 ± 1.15 (p < 0.001) and in DCP from 17.12 ± 11.56 to 12.21 ± 6.99 (p < 0.001), whereas the area of FAZ increased in SCP from 328.22 ± 131.38 to 399.70 ± 156.98 (p < 0.001) and in DCP from 571.13 ± 396.01 to 665.89 ± 412.77 (p = 0.001). The final BCVA letter score and CMT were statistically significant in both poor and good responders, as well as in BCVA < 75 and BCVA ≥ 75 groups. CONCLUSION The fixed-regimen intravitreal bevacizumab therapy was effective in treating DME. Apart from noninvasive visualization of microvascular damage, OCT-A showed limited usefulness in predicting treatment response. Although the study showed that the number of MAs was significantly reduced during treatment, which is an OCT-A predictor of a good response to bevacizumab treatment at a 12-month visit, commonly observed artifacts may reduce the usefulness of OCT-A.
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Affiliation(s)
- Magdalena Hunt
- Chair and Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-760 Katowice, Poland
- Department of Ophthalmology, District Railway Hospital in Katowice, 40-760 Katowice, Poland
| | - Sławomir Teper
- Chair and Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-760 Katowice, Poland
- Department of Ophthalmology, District Railway Hospital in Katowice, 40-760 Katowice, Poland
| | - Adam Wylęgała
- Health Promotion and Obesity Management Unit, Department of Pathophysiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Poland
| | - Edward Wylęgała
- Chair and Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-760 Katowice, Poland
- Department of Ophthalmology, District Railway Hospital in Katowice, 40-760 Katowice, Poland
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Yang K, Li C, Shi K, Zhu X, Xiao Y, Su B, Ju Y, Lu F, Qu J, Cui L, Li M. Association of Serum Uric Acid With Retinal Capillary Plexus. Front Endocrinol (Lausanne) 2022; 13:855430. [PMID: 35498412 PMCID: PMC9039338 DOI: 10.3389/fendo.2022.855430] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 03/15/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND To determine the association between serum uric acid (SUA) and the retinal capillary plexus (RCP) using optical coherence tomography angiography (OCTA). METHODS This cross-sectional study evaluated data from August 2019 to January 2020 from participants recruited from the Jidong community (Tangshan, Hebei, China). All participants completed detailed anthropometrical measurements, laboratory tests and comprehensive ophthalmic examinations. We assessed the vessel density in RCP using OCTA. We used multivariable analysis to evaluate the sex-specific association between SUA and RCP after adjusting for confounders. RESULTS A total of 2730 participants were included in this study. The mean age of the participants was 44.0 ± 11.6 years, and 1463 (53.6%) were women. The multivariable βs and 95% confidence intervals (CIs) of superficial RCP vessel density in the second through fourth SUA quartiles compared with the lowest SUA quartiles were -0.27 (-0.56 - 0.03), -0.30 (-0.60 - 0.01), and -0.46 (-0.78 - -0.14) (P for trend = 0.007) in men. CONCLUSIONS Higher SUA levels were significantly associated with lower RCP vessel density in men. Our findings provide evidence for the detrimental effect of high SUA levels on the retinal microvasculature and imply the importance of modulating SUA to prevent the microvascular alternation especially for men.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jia Qu
- *Correspondence: Ming Li, ; Lele Cui, ; Jia Qu,
| | - Lele Cui
- *Correspondence: Ming Li, ; Lele Cui, ; Jia Qu,
| | - Ming Li
- *Correspondence: Ming Li, ; Lele Cui, ; Jia Qu,
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Fan L, Zhu Y, Sun X, Yu J, Yan H. Patients with unilateral retinal vein occlusion show reduced radial peripapillary capillary density in their fellow eyes. BMC Ophthalmol 2021; 21:448. [PMID: 34961508 PMCID: PMC8711181 DOI: 10.1186/s12886-021-02192-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 11/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the radial peripapillary capillary (RPC) density in the fellow eyes of unilateral retinal vein occlusion (RVO) patients using optical coherence tomography angiography (OCTA), and further analyze the correlation between RPC density and peripapillary retinal nerve fiber layer (RNFL) thickness. METHODS Seventy-eight unilateral RVO patients and 70 normal controls were included in the study. OCTA was conducted with the 4.5 × 4.5-mm scan pattern centered on the optic nerve head, and the RPC density and peripapillary RNFL thickness were quantified. RESULTS The peripapillary RNFL in the RVO fellow eyes was significantly thinner than in normal controls in the average, inferior-hemisphere, inferior quadrant, and temporal quadrant (P < 0.05, respectively). The RPC density in the fellow eyes was also significantly lower in the average, inferior-hemisphere, nasal quadrant, and temporal quadrant ((P < 0.05, respectively). There were no significant differences in RNFL thickness and RPC density between branch RVO fellow eyes and central RVO fellow eyes. Pearson's correlation analysis showed significant positive correlations between the RPC density and RNFL thickness in all measurements (P < 0.001, respectively). CONCLUSIONS The regional RPC density was reduced in the RVO fellow eyes, which might contribute to peripapillary RNFL thinning in the corresponding region, suggesting the influence of systemic risk factors on RVO. OCTA may offer new insights into the pathophysiology of RVO.
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Affiliation(s)
- Lingling Fan
- Department of Ophthalmology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yazhou Zhu
- Department of Ophthalmology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xiaomei Sun
- Department of Ophthalmology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Jinguo Yu
- Department of Ophthalmology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Tianjin, 300052, China
| | - Hua Yan
- Department of Ophthalmology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Tianjin, 300052, China.
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Ren Q, Yu H, Sun Z, Li L. Analysis of choroidal thickness in patients with proliferative diabetic retinopathy by optical coherence tomography angiography. Pak J Med Sci 2021; 37:1943-1947. [PMID: 34912423 PMCID: PMC8613066 DOI: 10.12669/pjms.37.7.4357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/09/2021] [Accepted: 07/19/2021] [Indexed: 11/26/2022] Open
Abstract
Objectives: This study aimed to evaluate the changes in choroidal thickness at different parts in patients with stage IV-V diabetic retinopathy (DR) treated by Panretinal Photocoagulation (PRP) or its combination with anti-vascular endothelial growth factor (VEGF) therapy using optical coherence tomography angiography (OCTA). Methods: Patients with proliferative DR (stage IV-V) diagnosed in Shijiazhuang People’s Hospital between January 2016 to January 2020 were selected and treated with conventional PRP or combined with anti-VEGF therapy. OCTA was performed before treatment and one three and six months after treatment to observe and compare subfoveal choroidal thickness (SFCT), perifoveal choroidal thickness at 500 um (M500) and 1500 um (M1500). Results: A total of 76 patients (133 eyes) were included. Six months later, re-examination showed effective treatment in 122 eyes (91.72%) and ineffective treatment in 11 eyes. Before treatment and one week, three months and six months after treatment, the choroidal thickness was observed and compared by OCTA. SFCT, M500 and M1500 increased one week after treatment, were significantly thinner 3 months after treatment than those before treatment, and further decreased six months after treatment. Conclusion: OCTA presents a good evaluation of perifoveal choroidal thickness in patients with proliferative DR. It provides a basis for treatment selection and efficacy determination of proliferative DR.
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Affiliation(s)
- Qian Ren
- Qian Ren, Department of Ophthalmology, Shijiazhuang People's Hospital, Shijiazhuang, 050011, Hebei, China
| | - Hua Yu
- Hua Yu, Department of Ophthalmology, Shijiazhuang People's Hospital, Shijiazhuang, 050011, Hebei, China
| | - Zhaohui Sun
- Zhaohui Sun, Department of Ophthalmology, Shijiazhuang People's Hospital, Shijiazhuang, 050011, Hebei, China
| | - Li Li
- Li Li, Department of Ophthalmology, Shijiazhuang People's Hospital, Shijiazhuang, 050011, Hebei, China
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Zhu Z, Duan P, Song H, Zhou R, Chen T. Downregulation of Circular RNA PSEN1 ameliorates ferroptosis of the high glucose treated retinal pigment epithelial cells via miR-200b-3p/cofilin-2 axis. Bioengineered 2021; 12:12555-12567. [PMID: 34903141 PMCID: PMC8809929 DOI: 10.1080/21655979.2021.2010369] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Ferroptosis is a form of programmed cell death that participates in the progression of numerous diseases. Long noncoding RNAs (lncRNAs) are dysregulated in diabetic retinopathy (DR). However, the role of lncRNAs in DR-induced ferroptosis is unclear. Adult retinal pigment epithelial cell line-19 (ARPE19) cells were treated with a high concentration of glucose (high glucose, HG) to mimic DR in vitro. The intracellular contents of glutathione, malondialdehyde, and ferrous ions were analyzed using the corresponding kits. The MTT assay was performed to measure the cell survival rate, and cell death was determined using propidium iodide and terminal deoxynucleotidyl transferase dUTP nick end labeling staining assays. Western blotting was conducted to detect the protein levels of GPX4, SLC7A11, and TFR1. The targeting relationships were verified using luciferase reporter and RNA pull-down assays. circ-PSEN1 was upregulated in HG-treated ARPE19 cells and showed high resistance to RNase R and Act D. Inhibition of circ-PSEN1 in ARPE19 cells ameliorated the ferroptosis induced by HG was ameliorated, as evidenced by changes in the ferroptosis-related biomarkers/genes and decreased cell death. Subsequently, circ-PSEN1 acted as a sponge for miR-200b-3p. Inhibition of miR-200b-3p partially reversed the effects of circ-PSEN1 on ferroptosis. Furthermore, cofilin-2 (CFL2) was the target gene of miR-200b-3p, and it abrogated the inhibitory effect of miR-200b-3p on ferroptosis. Taken together, the findings indicate that knockdown of circ-PSEN1 can mitigate ferroptosis of ARPE19 cells induced by HG via the miR-200b-3p/CFL2 axis.
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Affiliation(s)
- Zhaoliang Zhu
- Ophthalmology Department, Xi'an People's Hospital, Shaanxi Eye Hospital, Xi'an City, China
| | - Peng Duan
- Ophthalmology Department, Xi'an People's Hospital, Shaanxi Eye Hospital, Xi'an City, China
| | - Huping Song
- Ophthalmology Department, Xi'an People's Hospital, Shaanxi Eye Hospital, Xi'an City, China
| | - Rongle Zhou
- Ophthalmology Department, Xi'an People's Hospital, Shaanxi Eye Hospital, Xi'an City, China
| | - Tao Chen
- Ophthalmology Department, Xi'an People's Hospital, Shaanxi Eye Hospital, Xi'an City, China
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Kaoual H, Zhioua Braham I, Boukari M, Zhioua R. Evaluation of the effect of the severity of diabetic retinopathy on microvascular abnormalities and vascular density using optical coherence tomography angiography. Acta Diabetol 2021; 58:1683-1688. [PMID: 34313844 DOI: 10.1007/s00592-021-01774-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/13/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE To quantify and to study the relationship between retinal microvascular changes and different stages of diabetic retinopathy (DR) using optical coherence tomography angiography (OCTA). METHODS This prospective observational study included the eyes of patients with different stages of DR. OCTA was performed in all eyes using a 9 × 9 mm protocol. We analyzed the superficial and deep retinal capillary plexuses, for the following OCTA parameters: number of microaneurysms (MA), number of intraretinal microvascular abnormalities (IRMA), the total surface of capillary non-perfusion (CNP) areas, and vascular density (VD). The association between those parameters and the severity of DR was studied. RESULTS A total of 70 eyes of 45 patients were included. The number of MA in the superficial capillary plexus (SCP) showed a significant association with DR severity (p = 0.03). The number of IRMA and the total surface of CNP areas were associated with the severity of DR in both plexuses (p = 0.019 in the SCP and p = 0.044 in the DCP for IRMA; p < 0.001 in the SCP and p = 0.001 in the DCP for CNP areas). The VD decreased significantly with the severity of DR in the DCP (p = 0.04). CONCLUSIONS The number of vascular abnormalities and the surface of CNP areas were significantly associated with the severity of DR. The decrease in vascular density in the DCP with increasing disease severity suggests that the DCP is more vulnerable to vascular changes than the SCP. Those parameters might be tools for a future DR severity scale based on OCTA. HIGHLIGHTS In addition to its capability of detecting vascular changes in DR non-invasively, OCTA may also serve as a valuable tool to graduate DR.
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Affiliation(s)
- Héla Kaoual
- Department of Ophthalmology, Charles Nicolle University Hospital of Tunis, Boulevard du 9-Avril 1938, 1006, Tunis, Tunisia.
| | - Imène Zhioua Braham
- Department of Ophthalmology, Charles Nicolle University Hospital of Tunis, Boulevard du 9-Avril 1938, 1006, Tunis, Tunisia
| | - Mejdi Boukari
- Department of Ophthalmology, Charles Nicolle University Hospital of Tunis, Boulevard du 9-Avril 1938, 1006, Tunis, Tunisia
| | - Raja Zhioua
- Department of Ophthalmology, Charles Nicolle University Hospital of Tunis, Boulevard du 9-Avril 1938, 1006, Tunis, Tunisia
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Palma F, Camacho P. The role of Optical Coherence Tomography Angiography to detect early microvascular changes in Diabetic Retinopathy: a systematic review. J Diabetes Metab Disord 2021; 20:1957-1974. [PMID: 34900835 PMCID: PMC8630307 DOI: 10.1007/s40200-021-00886-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/22/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE To evaluate quantitative parafoveal microvascular changes using Optical Coherence Tomography Angiography (OCTA) by comparing the area of foveal avascular zone (FAZ) and vessel density (VD) between nondiabetic controls and patients with different levels of Diabetic Retinopathy (DR). METHODS A systematic review was performed according to the recommendations of the "Cochrane Handbook for Systematic Reviews of Interventions" and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Three electronic databases including PubMed, Web of Science and Cochrane Library were systematically retrieved by using key terms with Boolean operators. The data extracted from each study included: first author, year of publication, study design, sample size and participant characteristics (mean age, type of diabetes mellitus and mean duration of diabetic disease). Outcome variables included: VD and area of FAZ, in superficial and deep capillary plexuses of parafovea. RESULTS 355 articles were identified from our search of databases and 10 studies were included in this systematic review. Patients with diabetes with or without clinical signs of DR have a significantly enlarged area of FAZ and decreased parafoveal VD compared to healthy controls, as well as an association between these microvascular changes and worsening DR. CONCLUSION OCTA can provide valuable information about early and subtle microvascular changes of parafoveal capillary plexuses in patients with diabetes and can identify preclinical DR before the manifestation of clinically apparent retinopathy. The non-invasive nature of OCTA allows routine imaging of the retinal vasculature, so this approach may be a promising tool for screening programmes of DR.
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Affiliation(s)
- Filipa Palma
- ESTeSL- Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Pedro Camacho
- H&TRC- Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Lisbon, Portugal
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Quantitative analysis and clinical application of iris circulation in ischemic retinal disease. BMC Ophthalmol 2021; 21:393. [PMID: 34781913 PMCID: PMC8594238 DOI: 10.1186/s12886-021-02165-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 11/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate quantitative changes in iris blood circulation in patients with ischemic risk. METHODS This observational case-control study included 79 patients with diabetic retinopathy (DR) and retinal vein occlusion (RVO). The RVO group included 21 patients; the monocular proliferative diabetic retinopathy (PDR) group included 19 patients; the nondiabetic retinopathy (NDR) group included 18 patients; and the healthy control group included 21 healthy controls. In the RVO group, we analyzed RVO affected eyes, RVO contralateral eyes, and healthy control eyes. We also compared eyes with PDR and contralateral eyes without PDR, patients with diabetes mellitus (DM) without DR, and healthy control eyes. The microvascular networks of the iris and retina were analyzed using optical coherence tomography angiography. The analysis included vessel area density (VAD) and vessel skeleton density (VSD) of iris and retina. RESULTS In the RVO group, the VAD and VSD of iris in the affected eye were higher than those in contralateral and healthy control eyes, and the VAD and VSD of contralateral eyes were higher than those of healthy control eyes. The retinal blood flow of the RVO eyes was less than that of the contralateral and healthy control eyes, but there were no difference between the contralateral eyes and healthy control eyes. The VAD and VSD of iris in PDR were larger than nonproliferative diabetic retinopathy (NPDR) and the NPDR were larger than NDR. There were no differences between NDR and healthy control eyes. Also, there were no differences among the four groups with respect to retinal blood flow. CONCLUSIONS Compared with the retina, iris blood circulation quantitative analysis data seem to be more sensitive to ischemia and may be used as a new predictor of ischemic disease, even if further research is needed to better understand the clinical value and importance of this analysis. TRIAL REGISTRATION The trial is registered with the clinical trial registration number nct03631108 .
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Savastano MC, Rizzo C, Gambini G, Savastano A, Falsini B, Bacherini D, Caputo CG, Kilian R, Faraldi F, De Vico U, Rizzo S. Choriocapillaris Vascular Density Changes: Healthy vs. Advanced Exudative Age-Related Macular Degeneration Previously Treated with Multiple Anti-VEGF Intravitreal Injections. Diagnostics (Basel) 2021; 11:diagnostics11111958. [PMID: 34829305 PMCID: PMC8621604 DOI: 10.3390/diagnostics11111958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/30/2021] [Accepted: 10/01/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose: To assess choriocapillaris vascular density (VD) in healthy and advanced exudative age-related macular degeneration (ae-AMD) patients by new full-range optical coherence tomography angiography (OCT-A). Method: In this observational, cross-sectional study, 21 healthy and 21 ae-AMD eyes, already treated with anti-VEGF, were enrolled. Angio-View retina patterns centered on fovea (6.4 × 6.4 mm) were acquired for all participants using Solix full-range OCT (Optovue Inc., Freemont, CA, USA). The main outcome was to compare choriocapillaris VD between healthy and ae-AMD eyes. Automated measurements of whole image choriocapillaris VD (%) and fovea grid-based (%) were collected for the analysis. Angio-View patterns were used to assess the flow area (mm2) of macular neovascularization (MNV) by contour flow measure algorithm. Best-corrected visual acuity (BCVA) of both groups was also used for the statistical analysis. Results: The mean age was 60.9 (±8.3) in healthy and 73.33 (±15.05) in ae-AMD eyes. The mean BCVA (ETDRS letters) was 98.47 (±1.50) in healthy and 7.04 (±5.96) in ae-AMD eyes. The Mann–Whitney test comparing choriocapillaries VD for whole and fovea healthy and ae-AMD eyes showed statistical significance (p < 0.0001 (t = 4.91; df = 40) and p < 0.0001 (t = 6.84; df = 40), respectively). Regarding, the correlation between MNV and VD of choriocapillaries, neither whole nor fovea areas were statistically significant (F = 0.38 (R2 = 0.01) and 1.68 (R2 = 0.08), respectively). Conclusions: Choriocapillaris VD showed a statistically significant reduction in comparison to healthy eyes in ae-AMD eyes. Choriocapillaris impairment can be seen in the early phase of MNV pathogenesis.
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Affiliation(s)
- Maria Cristina Savastano
- Unit of Ophthalmology, Fondazione Policlinico A. Gemelli, IRCCS, 00191 Rome, Italy; (G.G.); (A.S.); (B.F.); (C.G.C.); (U.D.V.); (S.R.)
- Unit of Ophthalmology, Università Cattolica Sacro Cuore, 00168 Rome, Italy
- Correspondence: (M.C.S.); (C.R.)
| | - Clara Rizzo
- Ophthalmology, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy
- Correspondence: (M.C.S.); (C.R.)
| | - Gloria Gambini
- Unit of Ophthalmology, Fondazione Policlinico A. Gemelli, IRCCS, 00191 Rome, Italy; (G.G.); (A.S.); (B.F.); (C.G.C.); (U.D.V.); (S.R.)
- Unit of Ophthalmology, Università Cattolica Sacro Cuore, 00168 Rome, Italy
| | - Alfonso Savastano
- Unit of Ophthalmology, Fondazione Policlinico A. Gemelli, IRCCS, 00191 Rome, Italy; (G.G.); (A.S.); (B.F.); (C.G.C.); (U.D.V.); (S.R.)
- Unit of Ophthalmology, Università Cattolica Sacro Cuore, 00168 Rome, Italy
| | - Benedetto Falsini
- Unit of Ophthalmology, Fondazione Policlinico A. Gemelli, IRCCS, 00191 Rome, Italy; (G.G.); (A.S.); (B.F.); (C.G.C.); (U.D.V.); (S.R.)
- Unit of Ophthalmology, Università Cattolica Sacro Cuore, 00168 Rome, Italy
| | - Daniela Bacherini
- Department of Surgery and Translational Medicine, AOU Careggi, University of Florence, 50139 Florence, Italy;
| | - Carmela Grazia Caputo
- Unit of Ophthalmology, Fondazione Policlinico A. Gemelli, IRCCS, 00191 Rome, Italy; (G.G.); (A.S.); (B.F.); (C.G.C.); (U.D.V.); (S.R.)
- Unit of Ophthalmology, Università Cattolica Sacro Cuore, 00168 Rome, Italy
| | - Raphael Kilian
- Ophthalmology Unit, University of Verona, 37134 Verona, Italy;
| | | | - Umberto De Vico
- Unit of Ophthalmology, Fondazione Policlinico A. Gemelli, IRCCS, 00191 Rome, Italy; (G.G.); (A.S.); (B.F.); (C.G.C.); (U.D.V.); (S.R.)
| | - Stanislao Rizzo
- Unit of Ophthalmology, Fondazione Policlinico A. Gemelli, IRCCS, 00191 Rome, Italy; (G.G.); (A.S.); (B.F.); (C.G.C.); (U.D.V.); (S.R.)
- Unit of Ophthalmology, Università Cattolica Sacro Cuore, 00168 Rome, Italy
- Consiglio Nazionale della Ricerca (CNR), Istituto di Neuroscienze, 56124 Pisa, Italy
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Le P, Zehden J, Zhang AY. Role of Optical Coherence Tomography Angiography Imaging in Patients with Diabetes. Curr Diab Rep 2021; 21:42. [PMID: 34665347 DOI: 10.1007/s11892-021-01405-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Ocular manifestations in patients with diabetes mellitus (DM) can present as microvascular changes. These microvascular changes can be challenging to identify on exams, and imaging technologies have commonly aided in the diagnosis and management of patients with DM. Optical coherence tomography angiography (OCTA) provides noninvasive image segmentation of various layers of the retina and choroid. Also, post-processing of images and associated quantitative measurements offer potential clinical enhancements. Our aim is to review the current evidence on the utility of OCTA for patients with DM. RECENT FINDINGS Research suggests OCTA to potentially provide potential clinical enhancements and alternative methods in detecting subclinical manifestation of diabetic retinopathy, staging diabetic retinopathy, management of diabetic macular edema, and monitoring of systemic markers in patients with diabetes mellitus. OCTA is a promising but relatively new modality, and differences in terminology, research designs, and image processing techniques provide a difficult landscape to navigate. Standardization within further validation is needed to determine the extent of OCTA's clinical utility, but the current literature suggests the potential for earlier detection of ocular manifestations in patients with DM, additional objective measurements for grading and management, and opportunity for additional biomarkers for treatment outcomes.
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Affiliation(s)
- Patrick Le
- Department of Ophthalmology, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | - Jason Zehden
- Department of Ophthalmology, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | - Alice Yang Zhang
- Department of Ophthalmology, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA.
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Shi H, Koronyo Y, Rentsendorj A, Fuchs DT, Sheyn J, Black KL, Mirzaei N, Koronyo-Hamaoui M. Retinal Vasculopathy in Alzheimer's Disease. Front Neurosci 2021; 15:731614. [PMID: 34630020 PMCID: PMC8493243 DOI: 10.3389/fnins.2021.731614] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 08/26/2021] [Indexed: 12/12/2022] Open
Abstract
The retina has been increasingly investigated as a site of Alzheimer’s disease (AD) manifestation for over a decade. Early reports documented degeneration of retinal ganglion cells and their axonal projections. Our group provided the first evidence of the key pathological hallmarks of AD, amyloid β-protein (Aβ) plaques including vascular Aβ deposits, in the retina of AD and mild cognitively impaired (MCI) patients. Subsequent studies validated these findings and further identified electroretinography and vision deficits, retinal (p)tau and inflammation, intracellular Aβ accumulation, and retinal ganglion cell-subtype degeneration surrounding Aβ plaques in these patients. Our data suggest that the brain and retina follow a similar trajectory during AD progression, probably due to their common embryonic origin and anatomical proximity. However, the retina is the only CNS organ feasible for direct, repeated, and non-invasive ophthalmic examination with ultra-high spatial resolution and sensitivity. Neurovascular unit integrity is key to maintaining normal CNS function and cerebral vascular abnormalities are increasingly recognized as early and pivotal factors driving cognitive impairment in AD. Likewise, retinal vascular abnormalities such as changes in vessel density and fractal dimensions, blood flow, foveal avascular zone, curvature tortuosity, and arteriole-to-venule ratio were described in AD patients including early-stage cases. A rapidly growing number of reports have suggested that cerebral and retinal vasculopathy are tightly associated with cognitive deficits in AD patients and animal models. Importantly, we recently identified early and progressive deficiency in retinal vascular platelet-derived growth factor receptor-β (PDGFRβ) expression and pericyte loss that were associated with retinal vascular amyloidosis and cerebral amyloid angiopathy in MCI and AD patients. Other studies utilizing optical coherence tomography (OCT), retinal amyloid-fluorescence imaging and retinal hyperspectral imaging have made significant progress in visualizing and quantifying AD pathology through the retina. With new advances in OCT angiography, OCT leakage, scanning laser microscopy, fluorescein angiography and adaptive optics imaging, future studies focusing on retinal vascular AD pathologies could transform non-invasive pre-clinical AD diagnosis and monitoring.
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Affiliation(s)
- Haoshen Shi
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Yosef Koronyo
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Altan Rentsendorj
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Dieu-Trang Fuchs
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Julia Sheyn
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Keith L Black
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Nazanin Mirzaei
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Maya Koronyo-Hamaoui
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States.,Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States
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Choi JM, Kim SM, Bae YH, Ma DJ. A Study of the Association Between Retinal Vessel Geometry and Optical Coherence Tomography Angiography Metrics in Diabetic Retinopathy. Invest Ophthalmol Vis Sci 2021; 62:14. [PMID: 34661607 PMCID: PMC8525825 DOI: 10.1167/iovs.62.13.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Purpose The purpose of this study was to investigate whether optical coherence tomography angiography (OCTA) metrics are related to retinal vessel geometry parameters in diabetic retinopathy (DR). Methods In total, 119 eyes (119 patients) were included in this retrospective cross-sectional study. Retinal vessel geometry parameters were analyzed using semi-automated software. OCTA metrics were analyzed using automated manufacturer-provided algorithms. Associations between the severity of DR and retinal vessel geometry parameters and OCTA metrics were evaluated. Multivariable regression analyses were performed to evaluate associations between retinal vessel geometry parameters and OCTA metrics after adjusting for clinical characteristics and DR severity. Results DR severity was negatively associated with the following: arteriole–venular ratio (P = 0.039), arteriolar network fractal dimension (FDa; P = 0.003), arteriolar junctional exponent deviation (P = 0.037), venular junctional exponent deviation (P = 0.036), vessel area density (VAD) of the superficial capillary plexus (SCP) and deep capillary plexus (DCP; P < 0.001, both), vessel length density (VLD) of the SCP and DCP (P < 0.001, both), and foveal avascular zone (FAZ) circularity (P < 0.001). DR severity was positively associated with the central retinal venular equivalent caliber (P = 0.005), arteriolar branching coefficient (BCa; P = 0.010), venular branching coefficient (P = 0.007), and FAZ size (P = 0.002). In multivariable regression analyses, the following retinal vessel geometry parameters and OCTA metrics were associated: FDa with VAD of the SCP (β = 0.40, P < 0.001), FDa with VLD of the SCP (β = 0.01, P < 0.001), and BCa with FAZ circularity (β = −1.02, P = 0.001). Conclusions In DR, changes in retinal arteriolar geometry parameters were significantly associated with OCTA metrics, which reflect DR pathophysiology.
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Affiliation(s)
- Ji Min Choi
- Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea
| | - Seong Mi Kim
- Department of Ophthalmology, Jeju National University College of Medicine, Jeju-si, Jeju-do, Republic of Korea
| | - Young Hwan Bae
- Department of Ophthalmology, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
| | - Dae Joong Ma
- Department of Ophthalmology, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
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Leitgeb R, Placzek F, Rank E, Krainz L, Haindl R, Li Q, Liu M, Andreana M, Unterhuber A, Schmoll T, Drexler W. Enhanced medical diagnosis for dOCTors: a perspective of optical coherence tomography. JOURNAL OF BIOMEDICAL OPTICS 2021; 26:JBO-210150-PER. [PMID: 34672145 PMCID: PMC8528212 DOI: 10.1117/1.jbo.26.10.100601] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/23/2021] [Indexed: 05/17/2023]
Abstract
SIGNIFICANCE After three decades, more than 75,000 publications, tens of companies being involved in its commercialization, and a global market perspective of about USD 1.5 billion in 2023, optical coherence tomography (OCT) has become one of the fastest successfully translated imaging techniques with substantial clinical and economic impacts and acceptance. AIM Our perspective focuses on disruptive forward-looking innovations and key technologies to further boost OCT performance and therefore enable significantly enhanced medical diagnosis. APPROACH A comprehensive review of state-of-the-art accomplishments in OCT has been performed. RESULTS The most disruptive future OCT innovations include imaging resolution and speed (single-beam raster scanning versus parallelization) improvement, new implementations for dual modality or even multimodality systems, and using endogenous or exogenous contrast in these hybrid OCT systems targeting molecular and metabolic imaging. Aside from OCT angiography, no other functional or contrast enhancing OCT extension has accomplished comparable clinical and commercial impacts. Some more recently developed extensions, e.g., optical coherence elastography, dynamic contrast OCT, optoretinography, and artificial intelligence enhanced OCT are also considered with high potential for the future. In addition, OCT miniaturization for portable, compact, handheld, and/or cost-effective capsule-based OCT applications, home-OCT, and self-OCT systems based on micro-optic assemblies or photonic integrated circuits will revolutionize new applications and availability in the near future. Finally, clinical translation of OCT including medical device regulatory challenges will continue to be absolutely essential. CONCLUSIONS With its exquisite non-invasive, micrometer resolution depth sectioning capability, OCT has especially revolutionized ophthalmic diagnosis and hence is the fastest adopted imaging technology in the history of ophthalmology. Nonetheless, OCT has not been completely exploited and has substantial growth potential-in academics as well as in industry. This applies not only to the ophthalmic application field, but also especially to the original motivation of OCT to enable optical biopsy, i.e., the in situ imaging of tissue microstructure with a resolution approaching that of histology but without the need for tissue excision.
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Affiliation(s)
- Rainer Leitgeb
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, Vienna, Austria
- Medical University of Vienna, Christian Doppler Laboratory OPTRAMED, Vienna, Austria
| | - Fabian Placzek
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, Vienna, Austria
| | - Elisabet Rank
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, Vienna, Austria
| | - Lisa Krainz
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, Vienna, Austria
| | - Richard Haindl
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, Vienna, Austria
| | - Qian Li
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, Vienna, Austria
| | - Mengyang Liu
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, Vienna, Austria
| | - Marco Andreana
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, Vienna, Austria
| | - Angelika Unterhuber
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, Vienna, Austria
| | - Tilman Schmoll
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, Vienna, Austria
- Carl Zeiss Meditec, Inc., Dublin, California, United States
| | - Wolfgang Drexler
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, Vienna, Austria
- Address all correspondence to Wolfgang Drexler,
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Zhao H, Yu M, Zhou L, Li C, Lu L, Jin C. Comparison of the Effect of Pan-Retinal Photocoagulation and Intravitreal Conbercept Treatment on the Change of Retinal Vessel Density Monitored by Optical Coherence Tomography Angiography in Patients with Proliferative Diabetic Retinopathy. J Clin Med 2021; 10:jcm10194484. [PMID: 34640502 PMCID: PMC8509421 DOI: 10.3390/jcm10194484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 11/17/2022] Open
Abstract
Background: This study compares the changes in retinal vessel density (VD) after pan-retinal photocoagulation (PRP) and intravitreal conbercept (IVC) treatment in proliferative diabetic retinopathy (PDR) eyes by optical coherence tomography angiography (OCTA). Methods: A total of 55 treatment-naïve PDR eyes were included in this retrospective study. Of these, 29 eyes were divided into a PRP group, and 26 eyes were divided into an IVC group based on the treatment they received. OCTA was performed to measure macular and papillary VD at each follow-up in both groups. Results: The macular VD for superficial capillary plexus (SCP), deep capillary plexus (DCP), choriocapillaris (CC) and papillary VD for radial peripapillary capillary (RPC) between the two groups demonstrated no significant difference at baseline and month 12 (p > 0.05). The paired t-test results showed that the macular VD for SCP, DCP, CC and papillary VD for the RPC at month 12 did not differ to the baseline in each group (p > 0.05). Conclusions: During the 12-month follow-up, there was no significant change of macular and papillary VD between the PRP and IVC treatment in PDR eyes. Additionally, compared to the baseline, there were no significant changes of macular and papillary VD after either the PRP or IVC treatment. Considering the decrease in VD as DR progress, both treatment modalities can potentially prevent macular and papillary VD loss in PDR.
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Affiliation(s)
- Hongkun Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou 510060, China; (H.Z.); (L.Z.); (C.L.); (L.L.)
| | - Minzhong Yu
- Electrophysiology Laboratory, Department of Ophthalmology, University Hospitals, Case Western Reserve University, Cleveland, OH 44106, USA;
| | - Lijun Zhou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou 510060, China; (H.Z.); (L.Z.); (C.L.); (L.L.)
| | - Cong Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou 510060, China; (H.Z.); (L.Z.); (C.L.); (L.L.)
| | - Lin Lu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou 510060, China; (H.Z.); (L.Z.); (C.L.); (L.L.)
| | - Chenjin Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou 510060, China; (H.Z.); (L.Z.); (C.L.); (L.L.)
- Correspondence:
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Horie S, Kukimoto N, Kamoi K, Igarashi-Yokoi T, Yoshida T, Ohno-Matsui K. Blue Widefield Images of Scanning Laser Ophthalmoscope Can Detect Retinal Ischemic Areas in Eyes With Diabetic Retinopathy. Asia Pac J Ophthalmol (Phila) 2021; 10:478-485. [PMID: 34456233 DOI: 10.1097/apo.0000000000000432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To determine whether the hyporeflective areas in the blue images obtained by widefield scanning laser ophthalmoscopy (SLO) correspond to the non-perfused areas (NPAs) in the fluorescein angiograms (FA) in eyes with diabetic retinopathy (DR). DESIGN Retrospective observational case series. METHODS Ninety patients with diabetes mellitus (DM) were studied. All had undergone multicolor widefield SLO imaging. The NPAs in the FA images and hyporeflective areas in the blue widefield SLO images were examined. The morphology of the retina was determined by optical coherence tomography. RESULTS Hyporeflective areas in the blue SLO images were found with a rate of 76.6% in eyes with proliferative DR eyes. In a comparison of the hyporeflective areas of the blue SLO images to the non-perfused areas in the FA images, the appearance and the correspondence in the locations of these two types of images were found, and the rate was highly concordant with a Cohen's kappa value of 0.675. CONCLUSIONS The high concordance between the hyporeflective areas in the widefield blue SLO and the NPAs in the FA indicates that widefield blue SLO can be used to identify ischemic retinal areas in eyes with DR without the intravenous injection of any dye.
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Affiliation(s)
- Shintaro Horie
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Advanced Ophthalmic Imaging, Tokyo Medical and Dental University, Tokyo, Japan
| | - Nobuyuki Kukimoto
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Koju Kamoi
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tae Igarashi-Yokoi
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takeshi Yoshida
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Advanced Ophthalmic Imaging, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
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Tey KY, Gan J, Foo V, Tan B, Ke MY, Schmetterer L, Mehta JS, Ang M. Role of anterior segment optical coherence tomography angiography in the assessment of acute chemical ocular injury: a pilot animal model study. Sci Rep 2021; 11:16625. [PMID: 34404833 PMCID: PMC8371111 DOI: 10.1038/s41598-021-96086-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/21/2021] [Indexed: 11/28/2022] Open
Abstract
To examine the use of anterior segment-optical coherence tomography angiography (AS-OCTA) in the assessment of limbal ischemia in an animal model chemical ocular injury. We conducted a prospective study using an established chemical ocular injury model in 6 rabbits (12 eyes), dividing the cornea limbus into 4 quadrants. Chemical injury grade was induced based on extent of limbal injury (0 to 360 degrees) and all eyes underwent serial slit-lamp with AS-OCTA imaging up to one month. Main outcome measure was changes in AS-OCTA vessel density (VD) comparing injured and control cornea limbal quadrants within 24 h and at one month. AS-OCTA was able to detect differences in limbal VD reduction comparing injured (3.3 ± 2.4%) and control quadrants (7.6 ± 2.3%; p < 0.001) within 24 h of ocular chemical injury. We also observed that AS-OCTA VD reduction was highly correlated with the number of quadrants injured (r = − 0.89; p < 0.001; 95% CI − 5.65 to − 1.87). Corneal vascularization was detected by AS-OCTA in injured compared to control quadrants (10.1 ± 4.3% vs 7.0 ± 1.2%; p = 0.025) at 1 month. Our animal pilot study suggests that AS-OCTA was able to detect limbal vessel disruption from various severities of acute chemical insult, and in the future, could potentially serve as an adjunct in providing objective grading of acute ocular chemical injury once validated in a clinical trial.
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Affiliation(s)
- Kai Yuan Tey
- Singapore Eye Research Institute, Singapore, Singapore
| | - Jinyuan Gan
- Duke-NUS Medical School, Singapore, Singapore
| | - Valencia Foo
- Singapore National Eye Centre, 20 College Rd, Singapore, 169856, Singapore
| | - Bingyao Tan
- Singapore Eye Research Institute, Singapore, Singapore.,SERI-NTU Advanced Ocular Engineering (STANCE) Program, Nanyang Technological University, Singapore, Singapore
| | - Meng Yuan Ke
- Singapore Eye Research Institute, Singapore, Singapore
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,SERI-NTU Advanced Ocular Engineering (STANCE) Program, Nanyang Technological University, Singapore, Singapore.,School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore, Singapore.,Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.,Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.,Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Jodhbir S Mehta
- Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,Singapore National Eye Centre, 20 College Rd, Singapore, 169856, Singapore
| | - Marcus Ang
- Singapore Eye Research Institute, Singapore, Singapore. .,Duke-NUS Medical School, Singapore, Singapore. .,Singapore National Eye Centre, 20 College Rd, Singapore, 169856, Singapore.
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Remolí Sargues L, Monferrer Adsuara C, Castro Navarro V, Navarro Palop C, Montero Hernández J, Soler Sanchis MI, Cervera Taulet E. Quantitative analysis of retinal and choroidal vasculature in patients with chorioretinal folds secondary to hyperopia. Eur J Ophthalmol 2021; 32:1694-1701. [PMID: 34308685 DOI: 10.1177/11206721211035618] [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: 11/15/2022]
Abstract
INTRODUCTION There is a lack of information on quantitative parameters of optical coherence tomography angiography (OCTA) in cases of chorioretinal folds (CRF). The aim of this study was to compare OCTA retinal and choriocapillary vessel density (VD) between normal subjects and patients with CRF. METHODS We conducted an observational retrospective study. A total of 16 eyes of eight patients were recruited (eight eyes with CRF and eight control eyes). Data on best-corrected visual acuity (BCVA), refractive error, central macular thickness (CMT), central subfoveal thickness (CST), and OCTA findings (VD and foveal avascular zone (FAZ) area in superficial capillary plexus (SCP), middle capillary plexus (MCP), and deep capillary plexus (DCP), and VD in choriocapillaris (CC)) were recorded in each eye. RESULTS Compared with control group, CRF group showed decreased VD in the foveal region of SCP and MCP (p value 0.003 and 0.001), and increased VD in nasal region of SCP and MCP (p value 0.02 and 0.001), and in parafoveal area of MCP (p value 0.005). No differences were found in DCP and CC layers. Furthermore, we observed an enlargement of FAZ in CRF group at SCP and MCP slabs (p value <0.001 and 0.015). Respect to optical coherence tomography parameters, we demonstrated a thicker choroid in the CRF group (p value 0.002). CONCLUSION To the best of our knowledge, this is the first study reported in the literature quantifying VD of retinal capillary plexus and CC in a group of patients with a diagnosis of CRF secondary to hyperopia.
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Affiliation(s)
- Lidia Remolí Sargues
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Clara Monferrer Adsuara
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Verónica Castro Navarro
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Catalina Navarro Palop
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | - Javier Montero Hernández
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
| | | | - Enrique Cervera Taulet
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Valencia, Spain
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Tan B, Sim YC, Chua J, Yusufi D, Wong D, Yow AP, Chin C, Tan ACS, Sng CCA, Agrawal R, Gopal L, Sim R, Tan G, Lamoureux E, Schmetterer L. Developing a normative database for retinal perfusion using optical coherence tomography angiography. BIOMEDICAL OPTICS EXPRESS 2021; 12:4032-4045. [PMID: 34457397 PMCID: PMC8367249 DOI: 10.1364/boe.423469] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/13/2021] [Accepted: 05/13/2021] [Indexed: 05/25/2023]
Abstract
Visualizing and characterizing microvascular abnormalities with optical coherence tomography angiography (OCTA) has deepened our understanding of ocular diseases, such as glaucoma, diabetic retinopathy, and age-related macular degeneration. Two types of microvascular defects can be detected by OCTA: focal decrease because of localized absence and collapse of retinal capillaries, which is referred to as the non-perfusion area in OCTA, and diffuse perfusion decrease usually detected by comparing with healthy case-control groups. Wider OCTA allows for insights into peripheral retinal vascularity, but the heterogeneous perfusion distribution from the macula, parapapillary area to periphery hurdles the quantitative assessment. A normative database for OCTA could estimate how much individual's data deviate from the normal range, and where the deviations locate. Here, we acquired OCTA images using a swept-source OCT system and a 12×12 mm protocol in healthy subjects. We automatically segmented the large blood vessels with U-Net, corrected for anatomical factors such as the relative position of fovea and disc, and segmented the capillaries by a moving window scheme. A total of 195 eyes were included and divided into 4 age groups: < 30 (n=24) years old, 30-49 (n=28) years old, 50-69 (n=109) years old and >69 (n=34) years old. This provides an age-dependent normative database for characterizing retinal perfusion abnormalities in 12×12 mm OCTA images. The usefulness of the normative database was tested on two pathological groups: one with diabetic retinopathy; the other with glaucoma.
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Affiliation(s)
- Bingyao Tan
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- NTU Institute for Health Technologies, Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Yin Ci Sim
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Jacqueline Chua
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, Singapore
| | - Dheo Yusufi
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Damon Wong
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- NTU Institute for Health Technologies, Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Ai Ping Yow
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- NTU Institute for Health Technologies, Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Calvin Chin
- Duke-NUS Medical School, Singapore
- National Heart Centre Singapore, Singapore
| | - Anna C. S. Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, Singapore
- Changi General Hospital, Singapore
| | - Chelvin C. A. Sng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Department of Ophthalmology, National University Hospital, Singapore
| | - Rupesh Agrawal
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | | | - Ralene Sim
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Gavin Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, Singapore
| | - Ecosse Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, Singapore
| | - Leopold Schmetterer
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- NTU Institute for Health Technologies, Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore
- Department of Clinical Pharmacology, Medical University of Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
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Hogg RE, Wright DM, Dolz-Marco R, Gray C, Waheed N, Teussink MM, Naskas T, Perais J, Das R, Quinn N, Bontzos G, Nicolaou C, Annam K, Young IS, Kee F, McGuiness B, Mc Kay G, MacGillivray T, Peto T, Chakravarthy U. Quantitative Parameters from OCT Angiography in Patients with Diabetic Retinopathy and in Those with Only Peripheral Retinopathy Compared with Control Participants. OPHTHALMOLOGY SCIENCE 2021; 1:100030. [PMID: 36249296 PMCID: PMC9559874 DOI: 10.1016/j.xops.2021.100030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/13/2021] [Accepted: 05/20/2021] [Indexed: 11/17/2022]
Abstract
Purpose To describe the differences in a range of quantitative OCT angiography (OCTA) metrics across early stages of diabetic retinopathy (DR), providing robust effect estimates as well as sensitivity and specificity. Design Cross-sectional study with population-based sampling. Participants Four hundred forty-one eyes from 296 individuals: 328 control eyes (no diabetes mellitus [DM] and no DR), 55 eyes with DM and no DR, and 58 eyes with early nonproliferative DR. Methods Multimodal retinal imaging included color fundus photography, color Optomap ultra-widefield imaging, and spectral-domain OCT (Spectralis OCT2; Heidelberg Engineering GmbH) with the OCTA module. All images were graded for the presence and severity of DR features. OCTA images were assessed manually for inclusion based on quality. Binary OCTA metrics were assessed after 3-dimensional projection artifact removal including from the nerve fiber layer vascular plexus, superficial vascular plexus (SVC), and deep vascular plexus (DVC) by Early Treatment Diabetic Retinopathy Study (ETDRS) grid, foveal avascular zone (FAZ) area, FAZ minimum and maximum diameter, perimeter length, and circularity. Main Outcome Measures Diabetes mellitus and DR status and presence or absence of DR in the retinal periphery. Results The reduction in vessel densities in participants with DM and manifest DR compared with control participants tended to be twice that of those with DM, but no DR, compared with control participants. Some evidence of spatial heterogeneity in vessel reductions was found in those yet to develop DR, whereas those with manifest DR had significant reductions across the ETDRS grid. The FAZ perimeter and circularity were impacted most significantly by DM, and those with DR showed decreased multispectral fractal dimensions compared with control participants. Eyes with peripheral DR had reduced vessel density compared with those with DM and no DR only in the superior outer, temporal inner, and temporal outer regions in the DVC and SVC. The area under the receiver operating characteristic curve ranged between 0.48 and 0.73. Conclusions Significant differences in OCTA metrics can be found in those with DM before manifest DR using commercially available equipment with minimal image postprocessing. Although diagnostic performance was poor, these metrics may be useful for measuring change over time in clinical trials.
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Key Words
- AUC, area under the receiver operating characteristic curve
- DM, diabetes mellitus
- DR, diabetic retinopathy
- DVC, deep vascular plexus
- Diabetes mellitus
- Diabetic retinopathy
- ETDRS, Early Treatment Diabetic Retinopathy Study
- FAZ, foveal avascular zone
- Foveal avascular zone
- NFLVP, nerve fiber layer vascular plexus
- NICOLA, Northern Ireland Cohort Study for the Longitudinal Study of Aging
- OCT angiography
- OCTA
- OCTA, OCT angiography
- Retinal periphery
- SVC, superficial vascular plexus
- Vessel density
- Vessel segmentation
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Affiliation(s)
- Ruth E. Hogg
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
- Correspondence: Ruth E. Hogg, PhD, Institute of Clinical Sciences, Block A, Centre for Public Health, Queen’s University Belfast, Belfast BT12 6BA, United Kingdom.
| | - David M. Wright
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | | | - Calum Gray
- Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Nadia Waheed
- School of Medicine, Tufts University, Boston, Massachusetts
| | | | - Timos Naskas
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - Jennifer Perais
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - Radha Das
- Moorfields Eye Hospital, London, United Kingdom
| | - Nicola Quinn
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | | | | | - Kaushik Annam
- School of Medicine, Louisiana State University, New Orleans, Louisiana
| | - Ian S. Young
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - Frank Kee
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | | | - Gareth Mc Kay
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - Tom MacGillivray
- Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Tunde Peto
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - Usha Chakravarthy
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
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49
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Quinn N, Jenkins A, Ryan C, Januszewski A, Peto T, Brazionis L. Imaging the eye and its relevance to diabetes care. J Diabetes Investig 2021; 12:897-908. [PMID: 33190401 PMCID: PMC8169343 DOI: 10.1111/jdi.13462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/08/2020] [Accepted: 11/10/2020] [Indexed: 11/28/2022] Open
Abstract
Diabetes is a major cause of vision loss globally, yet this devastating complication is largely preventable. Early detection and treatment of diabetic retinopathy necessitates screening. Ocular imaging is widely used clinically, both for the screening and management of diabetic retinopathy. Common eye conditions, such as glaucoma, cataracts and retinal vessel thrombosis, and signs of systemic conditions, such as hypertension, are frequently revealed. As well as imaging by a skilled clinician during an eye examination, non-ophthalmic clinicians, such as general practitioners, endocrinologists, nurses and trained health workers, can also can carry out diabetic eye screening. This process usually comprises local imaging with remote grading, mostly human grading. However, grading incorporating artificial intelligence is emerging. In a clinical research context, retinal vasculature analyses using semi-automated software in many populations have identified associations between retinal vessel geometry, such as vessel caliber, and the risk of diabetic retinopathy and other chronic complications of type 1 and type 2 diabetes. Similarly, evaluation of corneal nerves by corneal confocal microscopy is revealing diabetes-related abnormalities, and associations with and predictive power for other chronic diabetes complications. As yet, the value of retinal vessel geometry and corneal confocal microscopy measures at an individual level is uncertain. In this article, targeting non-ocular clinicians and researchers, we review existent and emerging ocular imaging and grading tools, including artificial intelligence, and their associations between ocular imaging findings and diabetes and its chronic complications.
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Affiliation(s)
- Nicola Quinn
- National Health and Medical Research Council Clinical Trials CenterThe University of SydneySydneyNew South WalesAustralia
- Center for Public HealthQueen’s University BelfastBelfastUK
| | - Alicia Jenkins
- National Health and Medical Research Council Clinical Trials CenterThe University of SydneySydneyNew South WalesAustralia
- Center for Public HealthQueen’s University BelfastBelfastUK
| | - Chris Ryan
- National Health and Medical Research Council Clinical Trials CenterThe University of SydneySydneyNew South WalesAustralia
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
| | - Andrzej Januszewski
- National Health and Medical Research Council Clinical Trials CenterThe University of SydneySydneyNew South WalesAustralia
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
| | - Tunde Peto
- Center for Public HealthQueen’s University BelfastBelfastUK
| | - Laima Brazionis
- National Health and Medical Research Council Clinical Trials CenterThe University of SydneySydneyNew South WalesAustralia
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
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50
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Kumar A, Agarwal D, Kumar A. Diabetic retinopathy screening and management in India: Challenges and possible solutions. Indian J Ophthalmol 2021; 69:479-481. [PMID: 33595458 PMCID: PMC7942083 DOI: 10.4103/ijo.ijo_2357_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Atul Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Divya Agarwal
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Aman Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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