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Lorenz AT, Pollreisz A, Schmidt-Erfurth U, Szurman P, Stanzel B. [OCT biomarkers in diabetic maculopathy and artificial intelligence]. DIE OPHTHALMOLOGIE 2024; 121:623-630. [PMID: 39012371 DOI: 10.1007/s00347-024-02065-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 05/03/2024] [Accepted: 06/06/2024] [Indexed: 07/17/2024]
Abstract
Diabetes mellitus is a chronic disease the microvascular complications of which include diabetic retinopathy and maculopathy. Diabetic macular edema, proliferative diabetic retinopathy, and diabetic macular ischemia pose a threat to visual acuity. Artificial intelligence can play an increasingly more important role in making the diagnosis and the treatment regimen of maculopathies in everyday clinical practice in the future. It can be used to automatically detect and quantify pathological parameters of the retina. The aim is to improve patient care in the clinical routine using so-called clinical decision support systems with personalized treatment algorithms. This review article outlines the current research regarding new biomarkers in diabetic maculopathy using optical coherence tomography (OCT) and OCT angiography (OCT-A).
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Affiliation(s)
- Anna Theresa Lorenz
- Augenklinik Sulzbach, Knappschaftsklinikum Saar, An der Klinik 10, 66280, Sulzbach, Deutschland
| | - Andreas Pollreisz
- Universitätsklinik für Augenheilkunde und Optometrie, Medizinische Universität Wien, Wien, Österreich
| | - Ursula Schmidt-Erfurth
- Universitätsklinik für Augenheilkunde und Optometrie, Medizinische Universität Wien, Wien, Österreich
| | - Peter Szurman
- Augenklinik Sulzbach, Knappschaftsklinikum Saar, An der Klinik 10, 66280, Sulzbach, Deutschland
- Klaus Heimann Eye Research Institute (KHERI), Sulzbach, Deutschland
| | - Boris Stanzel
- Augenklinik Sulzbach, Knappschaftsklinikum Saar, An der Klinik 10, 66280, Sulzbach, Deutschland.
- Klaus Heimann Eye Research Institute (KHERI), Sulzbach, Deutschland.
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Deng XY, Liu H, Zhang ZX, Li HX, Wang J, Chen YQ, Mao JB, Sun MZ, Shen LJ. Retinal vascular morphological characteristics in diabetic retinopathy: an artificial intelligence study using a transfer learning system to analyze ultra-wide field images. Int J Ophthalmol 2024; 17:1001-1006. [PMID: 38895683 PMCID: PMC11144771 DOI: 10.18240/ijo.2024.06.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/31/2024] [Indexed: 06/21/2024] Open
Abstract
AIM To investigate the morphological characteristics of retinal vessels in patients with different severity of diabetic retinopathy (DR) and in patients with or without diabetic macular edema (DME). METHODS The 239 eyes of DR patients and 100 eyes of healthy individuals were recruited for the study. The severity of DR patients was graded as mild, moderate and severe non-proliferative diabetic retinopathy (NPDR) according to the international clinical diabetic retinopathy (ICDR) disease severity scale classification, and retinal vascular morphology was quantitatively analyzed in ultra-wide field images using RU-net and transfer learning methods. The presence of DME was determined by optical coherence tomography (OCT), and differences in vascular morphological characteristics were compared between patients with and without DME. RESULTS Retinal vessel segmentation using RU-net and transfer learning system had an accuracy of 99% and a Dice metric of 0.76. Compared with the healthy group, the DR group had smaller vessel angles (33.68±3.01 vs 37.78±1.60), smaller fractal dimension (Df) values (1.33±0.05 vs 1.41±0.03), less vessel density (1.12±0.44 vs 2.09±0.36) and fewer vascular branches (206.1±88.8 vs 396.5±91.3), all P<0.001. As the severity of DR increased, Df values decreased, P=0.031. No significant difference between the DME and non-DME groups were observed in vascular morphological characteristics. CONCLUSION In this study, an artificial intelligence retinal vessel segmentation system is used with 99% accuracy, thus providing with relatively satisfactory performance in the evaluation of quantitative vascular morphology. DR patients have a tendency of vascular occlusion and dropout. The presence of DME does not compromise the integral retinal vascular pattern.
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Affiliation(s)
- Xin-Yi Deng
- Center for Rehabilitation Medicine, Department of Ophthalmology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou 310014, Zhejiang Province, China
| | - Hui Liu
- Department of Precision Machinery and Instrumentation, University of Science and Technology of China, Hefei 230026, Anhui Province, China
| | - Zheng-Xi Zhang
- Department of Retina, Eye Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Han-Xiao Li
- Center for Rehabilitation Medicine, Department of Ophthalmology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou 310014, Zhejiang Province, China
| | - Jun Wang
- Center for Rehabilitation Medicine, Department of Ophthalmology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou 310014, Zhejiang Province, China
| | - Yi-Qi Chen
- Center for Rehabilitation Medicine, Department of Ophthalmology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou 310014, Zhejiang Province, China
| | - Jian-Bo Mao
- Center for Rehabilitation Medicine, Department of Ophthalmology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou 310014, Zhejiang Province, China
| | - Ming-Zhai Sun
- Department of Precision Machinery and Instrumentation, University of Science and Technology of China, Hefei 230026, Anhui Province, China
| | - Li-Jun Shen
- Center for Rehabilitation Medicine, Department of Ophthalmology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou 310014, Zhejiang Province, China
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Li DS, Liao HX, Zhang CH, Huang JG, Chen W, Zhang JL, Qin B. Aflibercept combined with triamcinolone acetonide in the treatment of diabetic macular edema: optical coherence tomography and optical coherence tomography angiography. Int J Ophthalmol 2024; 17:670-675. [PMID: 38638246 PMCID: PMC10988085 DOI: 10.18240/ijo.2024.04.10] [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: 01/07/2024] [Accepted: 02/08/2024] [Indexed: 04/20/2024] Open
Abstract
AIM To analyze the relationship between optical coherence tomography (OCT) and OCT angiography (OCTA) imaging in patients with diabetic macular edema (DME) who are treated with a combination of aflibercept and triamcinolone acetonide (TA). METHODS A total of 76 eyes newly diagnosed DME were included in this study. They were randomly assigned to receive either aflibercept or a combination of aflibercept and TA. Injections once a month for a total of three injections. Central macular thickness (CMT), number of hyperreflective foci (HRF), height of subretinal fluid (SRF), and area of foveal avascular zone (FAZ) were evaluated using OCT and OCTA at baseline and after each monthly treatment. RESULTS Both groups showed improvement in best corrected visual acuity (BCVA) and reduction in macular edema after treatment, and the difference in BCVA between the two groups was statistically significant after each treatment (P<0.05). The difference in CMT between the two groups was statistically significant after the first two injections (P<0.01), but not after the third injection (P=0.875). The number of HRF (1mo: 7.41±8.25 vs 10.86±7.22, P=0.027; 2mo: 5.33±6.13 vs 9.12±8.61, P=0.034; 3mo: 3.58±3.00 vs 6.37±5.97, P=0.007) and height of SRF (1mo: 82.39±39.12 vs 105.77±42.26 µm, P=0.011; 2mo: 36.84±10.02 vs 83.59±37.78 µm, P<0.01; 3mo: 11.57±3.29 vs 45.43±12.60 µm, P<0.01) in combined group were statistically significant less than aflibercept group after each injection, while the area of FAZ showed no significant change before and after treatment in both groups. CONCLUSION The combination therapy of aflibercept and TA shows more significant effects on DME eyes with decreased HRF and SRF. However, both aflibercept and combination therapy show no significant change in the area of FAZ.
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Affiliation(s)
- De-Shuang Li
- Shenzhen Aier Eye Hospital, Aier Eye Hospital, Jinan University, Shenzhen 518031, Guangdong Province, China
| | - Hong-Xia Liao
- Shenzhen Aier Eye Hospital, Aier Eye Hospital, Jinan University, Shenzhen 518031, Guangdong Province, China
| | - Chuan-He Zhang
- Shenzhen Aier Eye Hospital, Aier Eye Hospital, Jinan University, Shenzhen 518031, Guangdong Province, China
| | - Jian-Guo Huang
- Shenzhen Aier Eye Hospital, Aier Eye Hospital, Jinan University, Shenzhen 518031, Guangdong Province, China
| | - Wei Chen
- Department of Ophthalmology, the University of Hong Kong-Shenzhen Hospital, Shenzhen 518000, Guangdong Province, China
| | - Jing-Lin Zhang
- Guangzhou Aier Eye Hospital, Jinan University, Guangzhou 510040, Guangdong Province, China
| | - Bo Qin
- Shenzhen Aier Eye Hospital, Aier Eye Hospital, Jinan University, Shenzhen 518031, Guangdong Province, China
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Wijesingha N, Tsai WS, Keskin AM, Holmes C, Kazantzis D, Chandak S, Kubravi H, Sivaprasad S. Optical Coherence Tomography Angiography as a Diagnostic Tool for Diabetic Retinopathy. Diagnostics (Basel) 2024; 14:326. [PMID: 38337841 PMCID: PMC10855126 DOI: 10.3390/diagnostics14030326] [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: 01/05/2024] [Revised: 01/29/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
Diabetic retinopathy (DR) is the most common microvascular complication of diabetes mellitus, leading to visual impairment if left untreated. This review discusses the use of optical coherence tomography angiography (OCTA) as a diagnostic tool for the early detection and management of DR. OCTA is a fast, non-invasive, non-contact test that enables the detailed visualisation of the macular microvasculature in different plexuses. OCTA offers several advantages over fundus fluorescein angiography (FFA), notably offering quantitative data. OCTA is not without limitations, including the requirement for careful interpretation of artefacts and the limited region of interest that can be captured currently. We explore how OCTA has been instrumental in detecting early microvascular changes that precede clinical signs of DR. We also discuss the application of OCTA in the diagnosis and management of various stages of DR, including non-proliferative diabetic retinopathy (NPDR), proliferative diabetic retinopathy (PDR), diabetic macular oedema (DMO), diabetic macular ischaemia (DMI), and pre-diabetes. Finally, we discuss the future role of OCTA and how it may be used to enhance the clinical outcomes of DR.
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Affiliation(s)
- Naomi Wijesingha
- UCL Institute of Ophthalmology, London EC1V 9EL, UK;
- Moorfields Eye Hospital, London EC1V 2PD, UK; (W.-S.T.); (A.M.K.); (C.H.); (D.K.); (S.C.); (H.K.)
| | - Wei-Shan Tsai
- Moorfields Eye Hospital, London EC1V 2PD, UK; (W.-S.T.); (A.M.K.); (C.H.); (D.K.); (S.C.); (H.K.)
| | - Ayse Merve Keskin
- Moorfields Eye Hospital, London EC1V 2PD, UK; (W.-S.T.); (A.M.K.); (C.H.); (D.K.); (S.C.); (H.K.)
| | - Christopher Holmes
- Moorfields Eye Hospital, London EC1V 2PD, UK; (W.-S.T.); (A.M.K.); (C.H.); (D.K.); (S.C.); (H.K.)
| | - Dimitrios Kazantzis
- Moorfields Eye Hospital, London EC1V 2PD, UK; (W.-S.T.); (A.M.K.); (C.H.); (D.K.); (S.C.); (H.K.)
| | - Swati Chandak
- Moorfields Eye Hospital, London EC1V 2PD, UK; (W.-S.T.); (A.M.K.); (C.H.); (D.K.); (S.C.); (H.K.)
| | - Heena Kubravi
- Moorfields Eye Hospital, London EC1V 2PD, UK; (W.-S.T.); (A.M.K.); (C.H.); (D.K.); (S.C.); (H.K.)
| | - Sobha Sivaprasad
- UCL Institute of Ophthalmology, London EC1V 9EL, UK;
- Moorfields Eye Hospital, London EC1V 2PD, UK; (W.-S.T.); (A.M.K.); (C.H.); (D.K.); (S.C.); (H.K.)
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Szeto SK, Lai TY, Vujosevic S, Sun JK, Sadda SR, Tan G, Sivaprasad S, Wong TY, Cheung CY. Optical coherence tomography in the management of diabetic macular oedema. Prog Retin Eye Res 2024; 98:101220. [PMID: 37944588 DOI: 10.1016/j.preteyeres.2023.101220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/24/2023] [Accepted: 10/24/2023] [Indexed: 11/12/2023]
Abstract
Diabetic macular oedema (DMO) is the major cause of visual impairment in people with diabetes. Optical coherence tomography (OCT) is now the most widely used modality to assess presence and severity of DMO. DMO is currently broadly classified based on the involvement to the central 1 mm of the macula into non-centre or centre involved DMO (CI-DMO) and DMO can occur with or without visual acuity (VA) loss. This classification forms the basis of management strategies of DMO. Despite years of research on quantitative and qualitative DMO related features assessed by OCT, these do not fully inform physicians of the prognosis and severity of DMO relative to visual function. Having said that, recent research on novel OCT biomarkers development and re-defined classification of DMO show better correlation with visual function and treatment response. This review summarises the current evidence of the association of OCT biomarkers in DMO management and its potential clinical importance in predicting VA and anatomical treatment response. The review also discusses some future directions in this field, such as the use of artificial intelligence to quantify and monitor OCT biomarkers and retinal fluid and identify phenotypes of DMO, and the need for standardisation and classification of OCT biomarkers to use in future clinical trials and clinical practice settings as prognostic markers and secondary treatment outcome measures in the management of DMO.
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Affiliation(s)
- Simon Kh Szeto
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Timothy Yy Lai
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Stela Vujosevic
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy; Eye Clinic, IRCCS MultiMedica, Milan, Italy
| | - Jennifer K Sun
- Beetham Eye Institute, Harvard Medical School, Boston, USA
| | - SriniVas R Sadda
- Doheny Eye Institute, University of California Los Angeles, Los Angeles, USA
| | - Gavin Tan
- Singapore Eye Research Institute, SingHealth Duke-National University of Singapore, Singapore
| | - Sobha Sivaprasad
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Tien Y Wong
- Tsinghua Medicine, Tsinghua University, Beijing, China; Singapore Eye Research Institute, Singapore
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
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Baldwin G, Vingopoulos F, Garg I, Moon JY, Zeng R, Cui Y, Katz R, Le R, Lu ES, Sayah DN, Hassan Z, Kim LA, Elze T, Husain D, Miller JB. Structure-function associations between contrast sensitivity and widefield swept-source optical coherence tomography angiography in diabetic macular edema. Graefes Arch Clin Exp Ophthalmol 2023; 261:3113-3124. [PMID: 37278906 DOI: 10.1007/s00417-023-06086-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 04/09/2023] [Accepted: 04/21/2023] [Indexed: 06/07/2023] Open
Abstract
PURPOSE To evaluate the relationship between contrast sensitivity (CS) and widefield swept-source optical coherence tomography angiography (WF SS-OCTA) vascular metrics in diabetic macular edema (DME) was the purpose. METHODS This prospectively enrolled cross-sectional observational study included 61 eyes of 48 patients that were tested with the quantitative CS function (qCSF) test on the same day as imaging with WF SS-OCTA (PLEX® Elite 9000, Carl Zeiss Meditec) 3 × 3, 6 × 6, and 12 × 12 mm scans. Outcomes included visual acuity (VA) and multiple qCSF metrics. Vascular metrics included vessel density (VD) and vessel skeletonized density (VSD) in the superficial (SCP) and deep capillary plexus (DCP) and whole retina (WR) and foveal avascular zone (FAZ) parameters. Mixed effects multivariable linear regression models controlling for age, lens status, and diabetic retinopathy stage were performed. Standardized beta coefficients were calculated by refitting the standardized data. RESULTS SS-OCTA metrics had a significant association with CS and VA. The effect size of OCTA metrics was larger on CS compared to VA. For example, the standardized beta coefficients for VSD and CS at 3 cpd (βSCP = 0.76, βDCP = 0.71, βWR = 0.72, p < 0.001) were larger than those for VA (βSCP = - 0.55, p < 0.001; βDCP = - 0.43, p = 0.004; βWR = - 0.50, p < 0.001). On 6 × 6 mm images, AULCSF, CS at 3 cpd, and CS at 6 cpd were significantly associated with VD and VSD in all three slab types (SCP, DCP, and WR), while VA was not. CONCLUSION Structure-function associations in patients with DME leveraging the qCSF device suggest microvascular changes on WF SS-OCTA are associated with larger changes in contrast sensitivity than VA.
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Affiliation(s)
- Grace Baldwin
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, 243 Charles St, Boston, MA, 02114, USA
| | - Filippos Vingopoulos
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, 243 Charles St, Boston, MA, 02114, USA
| | - Itika Garg
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, 243 Charles St, Boston, MA, 02114, USA
| | - Jade Y Moon
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, 243 Charles St, Boston, MA, 02114, USA
| | - Rebecca Zeng
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, 243 Charles St, Boston, MA, 02114, USA
| | - Ying Cui
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Raviv Katz
- Harvard Retinal Imaging Lab, Boston, MA, USA
| | - Rongrong Le
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Wenzhou Medical University Affiliated Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Edward S Lu
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, 243 Charles St, Boston, MA, 02114, USA
| | - Diane N Sayah
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, 243 Charles St, Boston, MA, 02114, USA
| | | | - Leo A Kim
- Retina Service, Massachusetts Eye and Ear, 243 Charles St, Boston, MA, 02114, USA
| | - Tobias Elze
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Boston, MA, USA
| | - Deeba Husain
- Retina Service, Massachusetts Eye and Ear, 243 Charles St, Boston, MA, 02114, USA
| | - John B Miller
- Harvard Retinal Imaging Lab, Boston, MA, USA.
- Retina Service, Massachusetts Eye and Ear, 243 Charles St, Boston, MA, 02114, USA.
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Güvenç U, Ünlü N, Yaralı HN, Özbek NY. Does thalassemia truly cause microvascular changes without us noticing? An optical coherence tomography angiography study of the children with beta-thalassemia. Int Ophthalmol 2023; 43:3755-3765. [PMID: 37389762 DOI: 10.1007/s10792-023-02786-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/22/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE It was aimed to evaluate the retinochoroidal microvascular alterations of pediatric beta-thalassemia patients and investigate the effect of blood transfusion on perfusion among transfusion-dependent thalassemia (TDT), by means of optical coherence tomography angiography (OCTA). METHODS In this multicentered, prospective, cross-sectional study, 56 TDT, 14 non-TDT (NTDT), and 63 healthy children were evaluated. The vessel density (VD) in superficial capillary plexus (SCP), deep capillary plexus, radial peripapillary capillary network, choriocapillaris, and the foveal avascular zone area (FAZ) were evaluated by OCTA. Before and after transfusion values of the TDT group were compared, and correlations were made with blood values and iron accumulation. RESULTS Foveal and parafoveal zones were significantly thinner among TDT patients, with larger FAZ area. Macula VD of SCP and ppVD was lowest in NTDT group. In the TDT group, a decrease in retinal nerve fiber thickness and ppVD values was detected after transfusion. A negative significant relationship was found between both hemoglobin (Hb), hematocrit (Htc), and ppVD. CONCLUSIONS OCTA provides a better insight into retinal and choriocapillaris vascular impairment influenced by tissue hypoxia and oxidative stress in different clinical phenotypes of beta-thalassemia.
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Affiliation(s)
- Umay Güvenç
- Ankara Training and Research Hospital Ophthalmology Department, Ankara, Turkey.
| | - Nurten Ünlü
- Ankara Training and Research Hospital Ophthalmology Department, Ankara, Turkey
| | - Hüsniye Neşe Yaralı
- Ankara City Hospital Pediatric Hematology and Oncology Department, Ankara, Turkey
| | - Namık Yaşar Özbek
- Ankara City Hospital Pediatric Hematology and Oncology Department, Ankara, Turkey
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Yang DW, Tang ZQ, Tang FY, Szeto SK, Chan J, Yip F, Wong CY, Ran AR, Lai TY, Cheung CY. Clinically relevant factors associated with a binary outcome of diabetic macular ischaemia: an OCTA study. Br J Ophthalmol 2023; 107:1311-1318. [PMID: 35450939 DOI: 10.1136/bjophthalmol-2021-320779] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 04/09/2022] [Indexed: 01/25/2023]
Abstract
AIMS We investigated the demographic, ocular, diabetes-related and systemic factors associated with a binary outcome of diabetic macular ischaemia (DMI) as assessed by optical coherence tomography angiography (OCTA) evaluation of non-perfusion at the level of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) in a cohort of patients with diabetes mellitus (DM). MATERIALS AND METHODS 617 patients with DM were recruited from July 2015 to December 2020 at the Chinese University of Hong Kong Eye Centre. Image quality assessment (gradable or ungradable for assessing DMI) and DMI evaluation (presence or absence of DMI) were assessed at the level of the SCP and DCP by OCTA. RESULTS 1107 eyes from 593 subjects were included in the final analysis. 560 (50.59%) eyes had DMI at the level of SCP, and 647 (58.45%) eyes had DMI at the level of DCP. Among eyes without diabetic retinopathy (DR), DMI was observed in 19.40% and 24.13% of eyes at SCP and DCP, respectively. In the multivariable logistic regression models, older age, poorer visual acuity, thinner ganglion cell-inner plexiform layer thickness, worsened DR severity, higher haemoglobin A1c level, lower estimated glomerular filtration rate and higher low-density lipoprotein cholesterol level were associated with SCP-DMI. In addition to the aforementioned factors, presence of diabetic macular oedema and shorter axial length were associated with DCP-DMI. CONCLUSION We reported a series of associated factors of SCP-DMI and DCP-DMI. The binary outcome of DMI might promote a simplified OCTA-based DMI evaluation before subsequent quantitative analysis for assessing DMI extent and fulfil the urge for an updating diabetic retinal disease staging to be implemented with OCTA.
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Affiliation(s)
- Da Wei Yang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Zi Qi Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Fang Yao Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Simon Kh Szeto
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
| | - Jason Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
| | - Fanny Yip
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
| | - Cherie Yk Wong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
| | - An Ran Ran
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Timothy Yy Lai
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
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Si M, Tao Y, Zhang Z, Zhao H, Cui W, Yang M, Wang H. Retinal vein changes in patients with high-risk proliferative diabetic retinopathy treated with conbercept and panretinal photocoagulation co-therapy: a cohort study. Front Endocrinol (Lausanne) 2023; 14:1218442. [PMID: 37693359 PMCID: PMC10485612 DOI: 10.3389/fendo.2023.1218442] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 08/10/2023] [Indexed: 09/12/2023] Open
Abstract
Objective This study aimed to observe and compare retinal vein diameter changes and other essential indicators in patients with high-risk proliferative diabetic retinopathy (PDR) treated with intravitreal injection of conbercept (IVC) combined with panretinal photocoagulation (PRP) versus PRP monotherapy. Methods A retrospective analysis was conducted on data from patients with high-risk PDR who received specific treatment and were followed up for 24 months. Among 82 patients with high-risk PDR, 50 eyes received PRP combined with IVC, whereas 32 eyes received PRP alone. During the 24-month follow-up period, changes in best-corrected visual acuity (BCVA), central foveal thickness (CFT), retinal vein diameter, number of microaneurysms (MA), neovascularization (NV) area, hard exudate (HE) area, size of the foveal avascular zone (FAZ), superficial capillary plexus (SCP) blood flow density, and adverse effects were recorded and compared between the two groups at baseline and at 6, 12, 18, and 24 months after treatment. The relationship between each observation index and vein diameter was also analyzed. Results During the 24-month follow up, significant improvements in the BCVA, CFT, retinal vein diameter, number of MAs, NV area, HE area, FAZ, and SCP were observed in the IVC+PRP group after treatment. The PRP group only showed significant reductions in NV and HE areas. The IVC+PRP group showed significant superiority over the PRP group in improving the vein diameter, number of MA, and HE area. However, no statistically significant difference in NV area reduction was found between the groups. Conclusion In the treatment of high-risk PDR, IVC+PRP therapy has a significant advantage over PRP monotherapy. IVC+PRP therapy may reverse diabetes-induced retinal vein changes, restoring morphology and function.
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Affiliation(s)
- Mingwei Si
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, China
| | - Yuan Tao
- Department of Ophthalmology, The Second People’s Hospital of Jinan, Jinan, China
| | - Ziniu Zhang
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Hui Zhao
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, China
| | - Wenxuan Cui
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, China
| | - Mengyao Yang
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, China
| | - Hong Wang
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, China
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10
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Viladés E, Cordón B, Pérez-Velilla J, Orduna E, Satue M, Polo V, Sebastian B, Larrosa JM, Pablo L, García-Martin E. Evaluation of multiple sclerosis severity using a new OCT tool. PLoS One 2023; 18:e0288581. [PMID: 37440532 DOI: 10.1371/journal.pone.0288581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
PURPOSE To assess the ability of a new posterior pole protocol to detect areas with significant differences in retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL) thickness in patients with multiple sclerosis versus healthy control subjects; in addition, to assess the correlation between RNFL and GCL thickness, disease duration, and the Expanded Disability Status Scale (EDSS). METHODS We analyzed 66 eyes of healthy control subjects and 100 eyes of remitting-relapsing multiple sclerosis (RR-MS) patients. Double analysis based on first clinical symptom onset (CSO) and conversion to clinically definite MS (CDMS) was performed. The RR-MS group was divided into subgroups by CSO and CDMS year: CSO-1 (≤ 5 years) and CSO-2 (≥ 6 years), and CDMS-1 (≤ 5 years) and CDMS-2 (≥ 6 years). RESULTS Significant differences in RNFL and GCL thickness were found between the RR-MS group and the healthy controls and between the CSO and CDMS subgroups and in both layers. Moderate to strong correlations were found between RNFL and GCL thickness and CSO and CDMS. Furthermore, we observed a strong correlation with EDSS 1 year after the OCT examination. CONCLUSIONS The posterior pole protocol is a useful tool for assessing MS and can reveal differences even in early stages of the disease. RNFL thickness shows a strong correlation with disability status, while GCL thickness correlates better with disease duration.
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Affiliation(s)
- Elisa Viladés
- Miguel Servet Ophthalmology Research and Innovation Group (GIMSO), Aragon Institute for Health Research (IIS Aragón), University of Zaragoza, Zaragoza, Spain
- Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain
| | - Beatriz Cordón
- Miguel Servet Ophthalmology Research and Innovation Group (GIMSO), Aragon Institute for Health Research (IIS Aragón), University of Zaragoza, Zaragoza, Spain
- Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain
| | - Javier Pérez-Velilla
- Miguel Servet Ophthalmology Research and Innovation Group (GIMSO), Aragon Institute for Health Research (IIS Aragón), University of Zaragoza, Zaragoza, Spain
| | - Elvira Orduna
- Miguel Servet Ophthalmology Research and Innovation Group (GIMSO), Aragon Institute for Health Research (IIS Aragón), University of Zaragoza, Zaragoza, Spain
- Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain
| | - Maria Satue
- Miguel Servet Ophthalmology Research and Innovation Group (GIMSO), Aragon Institute for Health Research (IIS Aragón), University of Zaragoza, Zaragoza, Spain
- Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain
| | - Vicente Polo
- Miguel Servet Ophthalmology Research and Innovation Group (GIMSO), Aragon Institute for Health Research (IIS Aragón), University of Zaragoza, Zaragoza, Spain
- Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain
| | - Berta Sebastian
- Miguel Servet Ophthalmology Research and Innovation Group (GIMSO), Aragon Institute for Health Research (IIS Aragón), University of Zaragoza, Zaragoza, Spain
- Neurology Department, Miguel Servet University Hospital, Zaragoza, Spain
| | - Jose Manuel Larrosa
- Miguel Servet Ophthalmology Research and Innovation Group (GIMSO), Aragon Institute for Health Research (IIS Aragón), University of Zaragoza, Zaragoza, Spain
- Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain
| | - Luis Pablo
- Miguel Servet Ophthalmology Research and Innovation Group (GIMSO), Aragon Institute for Health Research (IIS Aragón), University of Zaragoza, Zaragoza, Spain
- Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain
| | - Elena García-Martin
- Miguel Servet Ophthalmology Research and Innovation Group (GIMSO), Aragon Institute for Health Research (IIS Aragón), University of Zaragoza, Zaragoza, Spain
- Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain
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11
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Zhao T, Laotaweerungsawat S, Chen Y, Liu X, Liu D, Stewart JM. Right versus left eye asymmetry of microvasculature in diabetes revealed by optical coherence tomography angiography. Sci Rep 2023; 13:9332. [PMID: 37291258 PMCID: PMC10250307 DOI: 10.1038/s41598-023-36058-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 05/28/2023] [Indexed: 06/10/2023] Open
Abstract
In this study, we explored inter-ocular asymmetry (between the two eyes of the same patient) using optical coherence tomography angiography (OCTA) in patients with diabetes mellitus (DM) at different retinopathy stages. A total of 258 patients were divided into four groups: no DM, DM without diabetic retinopathy (DR), non-proliferative DR (NPDR), and proliferative DR (PDR). Superficial and deep vessel density (SVD, DVD), superficial and deep perfusion density (SPD, DPD), foveal avascular zone (FAZ) area, perimeter and circularity were calculated, and asymmetry index (AI) was used to evaluate the asymmetry of two eyes of the same subject. AIs of SPD, SVD, FAZ area and FAZ perimeter in the PDR group were larger than all other 3 groups (all p < 0.05). The AIs of DPD, DVD, FAZ area and FAZ perimeter in males were larger than in females (p = 0.015, p = 0.023, p = 0.006 and p = 0.017). Hemoglobin A1c (HbA1c) was positively correlated with AI of FAZ perimeter (p = 0.02) and circularity (p = 0.022). In conclusion, PDR patients' eyes were significantly asymmetric in both vascular density and FAZ metrics. Male sex and HbA1c are risk factors that influenced symmetry. This study highlights that right-left asymmetry should be taken into account in DR-related studies, particularly those analyzing microvascular changes with OCTA.
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Affiliation(s)
- Tong Zhao
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
- Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
- Department of Ophthalmology, China-Japan Friendship Hospital, Beijing, China
| | - Sawarin Laotaweerungsawat
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
- Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
- Department of Ophthalmology, Charoenkrung Pracharak Hospital, Bangkok, Thailand
| | - Yi Chen
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
- Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
- Shenzhen Key Laboratory of Ophthalmology, Shenzhen Eye Hospital, Jinan University, Shenzhen, China
- School of Optometry, Shenzhen University, Shenzhen, China
| | - Xiuyun Liu
- Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Dongwei Liu
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
- Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jay M Stewart
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA.
- Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.
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12
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Chouhan S, Kalluri Bharat RP, Surya J, Mohan S, Balaji JJ, Viekash VK, Lakshminarayanan V, Raman R. Preliminary Report on Optical Coherence Tomography Angiography Biomarkers in Non-Responders and Responders to Intravitreal Anti-VEGF Injection for Diabetic Macular Oedema. Diagnostics (Basel) 2023; 13:diagnostics13101735. [PMID: 37238219 DOI: 10.3390/diagnostics13101735] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 05/05/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
PURPOSE To identify optical coherence tomography angiography (OCTA) biomarkers in patients who were treated for diabetic macular oedema (DME) with intravitreal anti-vascular endothelial growth factor (VEGF) injections and compare the OCTA parameters between responders and non-responders. METHODS A retrospective cohort study of 61 eyes with DME who received at least one intravitreal anti-VEGF injection was included between July 2017 and October 2020. The subjects underwent a comprehensive eye examination followed by an OCTA examination before and after intravitreal anti-VEGF injection. Demographic data, visual acuity, and OCTA parameters were documented, and further analysis was performed pre- and post-intravitreal anti-VEGF injection. RESULTS Out of 61 eyes which underwent intravitreal anti-VEGF injection for diabetic macular oedema, 30 were responders (group 1) and 31 were non-responders (group 2). We found that the responders (group 1) had a higher vessel density in the outer ring that was statistically significant (p = 0.022), and higher perfusion density was noted in the outer ring (p = 0.012) and full ring (p = 0.044) at levels of the superficial capillary plexus (SCP). We also observed a lower vessel diameter index in the deep capillary plexus (DCP) in responders when compared to non-responders (p < 0.00). CONCLUSION The evaluation of SCP in OCTA in addition to DCP can result in a better prediction of treatment response and early management in diabetic macular oedema.
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Affiliation(s)
- Sanjana Chouhan
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai 600006, India
| | | | - Janani Surya
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai 600006, India
| | - Sashwanthi Mohan
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai 600006, India
| | | | - V K Viekash
- Department of Instrumentation and Control Engineering, National Institute of Technology, Tiruchirappalli 620015, India
| | - Vasudevan Lakshminarayanan
- Theoretical and Experimental Epistemology Lab, School of Optometry and Vision Science, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai 600006, India
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13
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Szeto SKH, Hui VWK, Siu V, Mohamed S, Chan CKM, Cheung CYL, Hsieh YT, Tan CS, Chhablani J, Lai TYY, Ng DSC. Recent Advances in Clinical Applications of Imaging in Retinal Diseases. Asia Pac J Ophthalmol (Phila) 2023; 12:252-263. [PMID: 36650100 DOI: 10.1097/apo.0000000000000584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 10/24/2022] [Indexed: 01/19/2023] Open
Abstract
Many diseases that cause visual impairment, as well as systemic conditions, manifest in the posterior segment of the eye. With the advent of high-speed, high-resolution, reliable, and noninvasive imaging techniques, ophthalmologists are becoming more dependent on ocular imaging for disease diagnosis, classification, and management in clinical practice. There are rapid advances on the indications of multimodal retinal imaging techniques, including the application of ultra-widefield fundus angiography, fundus autofluorescence, optical coherence tomography, as well as optical coherence tomography angiography. This review summarizes and highlights the clinical applications, latest indications, and interpretations of multimodal imaging in age-related macular degeneration, polypoidal choroidal vasculopathy, diabetic macular edema, central serous chorioretinopathy, diabetic retinopathy, retinal vein occlusion, and uveitis.
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Affiliation(s)
- Simon Ka-Ho Szeto
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Hong Kong, China
| | - Vivian Wing Ki Hui
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Hong Kong, China
| | - Vivianna Siu
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Shaheeda Mohamed
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Hong Kong, China
| | - Carmen K M Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Hong Kong, China
| | - Carol Yim Lui Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Yi Ting Hsieh
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Colin S Tan
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Timothy Y Y Lai
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Hong Kong, China
- 2010 Retina and Macula Centre, Hong Kong, China
| | - Danny Siu-Chun Ng
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Hong Kong, China
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14
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Choi YJ, Seol BR. Effects of Cataract on Retinal Nerve Fiber Layer and Ganglion Cell-Inner Plexiform Layer Thickness on Swept Source Optical Coherence Tomography. KOREAN JOURNAL OF OPHTHALMOLOGY 2023; 37:12-22. [PMID: 36281576 PMCID: PMC9935059 DOI: 10.3341/kjo.2022.0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/24/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate the changes in peripapillary retinal nerve fiber layer (pRNFL) thickness and macular ganglion cell-inner plexiform layer (mGC-IPL) thickness measured by swept source optical coherence tomography (SS-OCT) following cataract surgery in patients with glaucoma. METHODS We included 42 glaucoma eyes and 42 case-matched normal eyes that underwent cataract surgery without complications. One matching set included one glaucoma eye and one case-matched normal eye. The age, sex, and cataract subtype scores were similar for each group. Before and within 3 months of surgery, we measured the pRNFL thickness and mGCIPL thickness by SS-OCT. RESULTS Following cataract surgery, the image quality (IQ) of SS-OCT improved in both groups. The thickness of the pRNFL and mGC-IPL increased in the mean values and all areas, except for pRNFL from 1 to 4 o'clock in the glaucoma group and at 1 o'clock in the normal group. Posterior subcapsular cataract was related to the change in IQ following surgery. The glaucoma and normal group showed greater pRNFL thickness change due to lesser preoperative pRNFL thickness. Furthermore, the mGC-IPL thickness change was greater in the glaucoma group because of lesser preoperative mGC-IPL thickness. By contrast, the normal group demonstrated greater mGC-IPL thickness change due to higher cortical cataract scores. CONCLUSIONS Cataracts caused the deterioration of the IQ in SS-OCT, thereby resulting in an undermeasurement of the pRNFL and mGC-IPL thickness. Preoperative pRNFL and mGC-IPL were negatively associated with postoperative pRNFL and mGCIPL thickness change in the glaucoma and normal groups. Therefore, ophthalmologists should particularly consider the effect of cataract while diagnosing glaucoma using SS-OCT.
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Affiliation(s)
- Young-Je Choi
- Department of Ophthalmology, Veterans Health Service Medical Center, Seoul, Korea
| | - Bo Ram Seol
- Department of Ophthalmology, Veterans Health Service Medical Center, Seoul, Korea
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15
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Ding Q, Wu H, Wang W, Xiong K, Gong X, Yuan G, Li T, Li Y, Liu H, Wang L, Huang W. Association of Body Mass Index and Waist-to-Hip Ratio With Retinal Microvasculature in Healthy Chinese Adults: An Optical Coherence Tomography Angiography Study. Am J Ophthalmol 2023; 246:96-106. [PMID: 36240858 DOI: 10.1016/j.ajo.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 09/14/2022] [Accepted: 09/20/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE To investigate the association of body mass index (BMI) and waist-to-hip ratio (WHR) with macular vessel density (VD) and foveal avascular zone (FAZ), using optical coherence tomography angiography (OCTA), in healthy Chinese adults. DESIGN Cross-sectional study. METHODS A total of 1555 Chinese adults aged ≥ 50 years with no history of ocular disease were recruited from communities in Guangzhou, China. The OCTA was performed with a 6 × 6 mm macular angiography model. The FAZ of the superficial capillary plexus (SCP), and VD of SCP and deep capillary plexus (DCP) were calculated. Univariable and multivariable linear regression analyses were used to evaluate the effect of BMI and WHR on VD and FAZ. RESULTS The VD of the SCP increased as BMI increased, with average measurements of 39.30 ± 2.14 for normal, 39.52 ± 2.07 for overweight, and 39.76 ± 2.03 for obesity (P = .001). The VD of the DCP also increased with increasing BMI (P = .009). Multiple regression models confirmed a positive association between generalized obesity and superficial VD in the whole image (β = 0.350, P = .008), inner circle (β = 0.431, P = .032), and outer circle (β = 0.368, P = .005). After adjusting for confounders, tertile 3 of the WHR level was positively associated with superficial VD (β = 0.472, P = .033) and deep VD (β = 0.422, P = .034) only in the inner circle. CONCLUSIONS Generalized obesity was associated with increased superficial VD, while abdominal obesity was associated with increased superficial and deep VD only in the inner circle. Different manifestations of the retinal microvasculature may reflect distinct roles of body composition on macular vessel alterations and disease occurrence.
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Affiliation(s)
- Qiong Ding
- From State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China (Q.D, W.W., K.X., X.G., L.W., W.H.); The First People's Hospital of Zhaoqing, Zhaoqing City, China (Q.D., G.Y., T.L., Y.L.)
| | - Huimin Wu
- Shenzhen Children's Hospital, Shenzhen, Guangdong, China (H.W.)
| | - Wei Wang
- From State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China (Q.D, W.W., K.X., X.G., L.W., W.H.)
| | - Kun Xiong
- From State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China (Q.D, W.W., K.X., X.G., L.W., W.H.)
| | - Xia Gong
- From State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China (Q.D, W.W., K.X., X.G., L.W., W.H.)
| | - Guiliang Yuan
- The First People's Hospital of Zhaoqing, Zhaoqing City, China (Q.D., G.Y., T.L., Y.L.)
| | - Tengchao Li
- The First People's Hospital of Zhaoqing, Zhaoqing City, China (Q.D., G.Y., T.L., Y.L.)
| | - Youjia Li
- The First People's Hospital of Zhaoqing, Zhaoqing City, China (Q.D., G.Y., T.L., Y.L.)
| | - Hua Liu
- Department of Ophthalmology, Third Affiliated Hospital of Jinzhou Medical University, Jinzhou, China (H.L.).
| | - Lanhua Wang
- From State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China (Q.D, W.W., K.X., X.G., L.W., W.H.).
| | - Wenyong Huang
- From State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China (Q.D, W.W., K.X., X.G., L.W., W.H.)
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16
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Diabetic Retinopathy: Soluble and Imaging Ocular Biomarkers. J Clin Med 2023; 12:jcm12030912. [PMID: 36769560 PMCID: PMC9917666 DOI: 10.3390/jcm12030912] [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: 12/31/2022] [Revised: 01/18/2023] [Accepted: 01/22/2023] [Indexed: 01/26/2023] Open
Abstract
Diabetic retinopathy (DR), the most common microvascular complication of diabetes mellitus, represents the leading cause of acquired blindness in the working-age population. Due to the potential absence of symptoms in the early stages of the disease, the identification of clinical biomarkers can have a crucial role in the early diagnosis of DR as well as for the detection of prognostic factors. In particular, imaging techniques are fundamental tools for screening, diagnosis, classification, monitoring, treatment planning and prognostic assessment in DR. In this context, the identification of ocular and systemic biomarkers is crucial to facilitate the risk stratification of diabetic patients; moreover, reliable biomarkers could provide prognostic information on disease progression as well as assist in predicting a patient's response to therapy. In this context, this review aimed to provide an updated and comprehensive overview of the soluble and anatomical biomarkers associated with DR.
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Zhang CH, Gong B, Huang C, Shu XW, Chen TY, Chen X, Wu CL, Wang Y. Morphological and functional changes in the macular area in diabetic macular edema after a single intravitreal injection of aflibercept. Int J Ophthalmol 2023; 16:88-94. [PMID: 36659946 PMCID: PMC9815978 DOI: 10.18240/ijo.2023.01.13] [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: 05/07/2022] [Accepted: 11/10/2022] [Indexed: 12/30/2022] Open
Abstract
AIM To evaluate the changes in macular morphology and function after a single intravitreal injection of aflibercept in diabetic macular edema (DME) using optical coherence tomography angiography (OCTA) and MP-3 microperimetry. METHODS Twenty-eight patients (42 eyes) diagnosed with DME were treated with intravitreal injection of aflibercept. The changes in best corrected visual acuity (BCVA), central retinal thickness (CRT), foveal avascular zone (FAZ) area, vessel density of superficial retinal capillary plexus (SVD), vessel density of deep retinal capillary plexus (DVD), mean light sensitivity (MLS), 2° fixation rate (P1), 4° fixation rate (P2), and other indicators 1mo after treatment were compared; of these, BCVA was converted into logarithm of the minimum angle of resolution (logMAR), and the correlation among the factors was analyzed. RESULTS After treatment, logMAR BCVA was 0.47±0.24, which was significantly better than that before treatment (0.63±0.28, P<0.001). The CRT was 359.21±107.87 µm after treatment, which was significantly lower than before treatment (474.10±138.20 µm, P<0.001). The FAZ area, SVD, and DVD were not significantly changed after treatment compared with the baseline. MLS was 22.16±4.20 dB after treatment, which was significantly higher than before treatment (19.63±4.23 dB, P<0.001). P2 significantly increased after treatment than before treatment (P=0.007). P1 had no significant change after treatment than before treatment (P=0.086). CONCLUSION A single intravitreal injection of aflibercept effectively reduces macular edema and improves retinal sensitivity, fixation stability, and visual acuity, possibly without causing significant changes in the retinal vascular condition in a short time.
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Affiliation(s)
- Chuan-He Zhang
- Shenzhen Aier Eye Hospital, Aier Eye Hospital, Jinan University, Shenzhen 518031, Guangdong Province, China
| | - Bin Gong
- Department of Ophthalmology, Jinan Second People's Hospital, Jinan 250001, Shandong Province, China
| | - Chao Huang
- Department of Ophthalmology, Jinan Second People's Hospital, Jinan 250001, Shandong Province, China
| | - Xiang-Wen Shu
- Department of Ophthalmology, Jinan Second People's Hospital, Jinan 250001, Shandong Province, China
| | - Tian-Yu Chen
- Medical Department, Wuxi Second People's Hospital, Wuxi 214001, Jiangsu Province, China
| | - Xuan Chen
- Department of Ophthalmology, Jinan Second People's Hospital, Jinan 250001, Shandong Province, China
| | - Chang-Long Wu
- Department of Ophthalmology, Jinan Second People's Hospital, Jinan 250001, Shandong Province, China
| | - Yu Wang
- Department of Ophthalmology, Jinan Second People's Hospital, Jinan 250001, Shandong Province, China
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Deep Learning in Optical Coherence Tomography Angiography: Current Progress, Challenges, and Future Directions. Diagnostics (Basel) 2023; 13:diagnostics13020326. [PMID: 36673135 PMCID: PMC9857993 DOI: 10.3390/diagnostics13020326] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
Optical coherence tomography angiography (OCT-A) provides depth-resolved visualization of the retinal microvasculature without intravenous dye injection. It facilitates investigations of various retinal vascular diseases and glaucoma by assessment of qualitative and quantitative microvascular changes in the different retinal layers and radial peripapillary layer non-invasively, individually, and efficiently. Deep learning (DL), a subset of artificial intelligence (AI) based on deep neural networks, has been applied in OCT-A image analysis in recent years and achieved good performance for different tasks, such as image quality control, segmentation, and classification. DL technologies have further facilitated the potential implementation of OCT-A in eye clinics in an automated and efficient manner and enhanced its clinical values for detecting and evaluating various vascular retinopathies. Nevertheless, the deployment of this combination in real-world clinics is still in the "proof-of-concept" stage due to several limitations, such as small training sample size, lack of standardized data preprocessing, insufficient testing in external datasets, and absence of standardized results interpretation. In this review, we introduce the existing applications of DL in OCT-A, summarize the potential challenges of the clinical deployment, and discuss future research directions.
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Li M, Mao M, Wei D, Liu M, Liu X, Leng H, Wang Y, Chen S, Zhang R, Zeng Y, Wang M, Li J, Zhong J. Different scan areas affect the detection rates of diabetic retinopathy lesions by high-speed ultra-widefield swept-source optical coherence tomography angiography. Front Endocrinol (Lausanne) 2023; 14:1111360. [PMID: 36891051 PMCID: PMC9986411 DOI: 10.3389/fendo.2023.1111360] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/06/2023] [Indexed: 02/22/2023] Open
Abstract
INTRODUCTION The study aimed to determine the effect of the scanning area used for high-speed ultra-widefield swept-source optical coherence tomography angiography (SS-OCTA) on the detection rate of diabetic retinopathy (DR) lesions. METHODS This prospective, observational study involved diabetic patients between October 2021 and April 2022. The participants underwent a comprehensive ophthalmic examination and high-speed ultra-widefield SS-OCTA using a 24 mm × 20 mm scanning protocol. A central area denoted as "12 mm × 12 mm-central" was extracted from the 24 mm × 20 mm image, and the remaining area was denoted as "12 mm~24mm-annulus." The rates of detection of DR lesions using the two scanning areas were recorded and compared. RESULTS In total, 172 eyes (41 eyes with diabetes mellitus without DR, 40 eyes with mild to moderate non-proliferative diabetic retinopathy (NPDR), 51 eyes with severe NPDR, and 40 eyes with proliferative diabetic retinopathy (PDR) from 101 participants were included. The detection rates of microaneurysms (MAs), intraretinal microvascular abnormalities (IRMAs), and neovascularization (NV) for the 12 mm × 12 mm central and 24 mm × 20 mm images were comparable (p > 0.05). The detection rate of NPAs for the 24 mm × 20 mm image was 64.5%, which was significantly higher than that for the 12 mm × 12 mm central image (52.3%, p < 0.05). The average ischemic index (ISI) was 15.26% for the 12 mm~24mm-annulus, which was significantly higher than that for the 12 mm × 12 mm central image (5.62%). Six eyes had NV and 10 eyes had IRMAs that only existed in the 12 mm~24mm-annulus area. CONCLUSIONS The newly developed high-speed ultra-widefield SS-OCTA can capture a 24 mm × 20 mm retinal vascular image during a single scan, which improves the accuracy of detecting the degree of retinal ischemia and detection rate of NV and IRMAs.
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Affiliation(s)
- Mengyu Li
- Department of Ophthalmology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Department of Ophthalmology, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
- Eye School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Mingzhu Mao
- Department of Ophthalmology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Department of Ophthalmology, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Dingyang Wei
- Department of Ophthalmology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Department of Ophthalmology, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Miao Liu
- Department of Ophthalmology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Department of Ophthalmology, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
- Eye School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xinyue Liu
- Department of Ophthalmology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Department of Ophthalmology, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
- Eye School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hongmei Leng
- Department of Ophthalmology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Department of Ophthalmology, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yiya Wang
- Department of Ophthalmology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Department of Ophthalmology, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Sizhu Chen
- Department of Ophthalmology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Department of Ophthalmology, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
- Eye School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ruifan Zhang
- Department of Ophthalmology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Department of Ophthalmology, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Yong Zeng
- Department of Ophthalmology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Department of Ophthalmology, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Min Wang
- Department of Ophthalmology, Dayi Shaoxiang Hospital, Chengdu, China
| | - Jie Li
- Department of Ophthalmology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Department of Ophthalmology, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
- *Correspondence: Jie Zhong, ; Jie Li,
| | - Jie Zhong
- Department of Ophthalmology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Department of Ophthalmology, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
- *Correspondence: Jie Zhong, ; Jie Li,
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20
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Nourinia R, Rajavi Z, Sabbaghi H, Hassanpour K, Ahmadieh H, Kheiri B, Rajabpour M. Optical Coherence Tomography Angiography in Patients with Amblyopia. Strabismus 2022; 30:132-138. [PMID: 35822401 DOI: 10.1080/09273972.2022.2097705] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
To determine the optical coherence tomography angiography (OCTA) parameters including foveal avascular zone (FAZ) and vessel density (VD) in the amblyopic eyes compared with the fellow sound eyes and the eyes of the non-amblyopic subjects. In this case-control study, a total of 23 eyes from unilateral amblyopic children were included as cases. The sound eye of the amblyopic children was considered as the internal control and the right eyes of the non-amblyopic children were considered as the external control. All participants underwent image recording with OCTA. In the present study, an equal number of 23 unilateral amblyopic eyes and 23 right eyes of non-amblyopic age- and sex-matched children were included as the cases and controls, respectively. The average age of participants in the case and controls were 9.86 ± 3.12 and 8.5 ± 2.35 years, respectively. Twelve patients (52.2%) in the case group and 14 subjects (60.9%) in the control group were female. Whole vascular density of the macula in superficial capillary plexuses (SCP) was significantly lower in the external controls compared with the other studied groups (P = .026). However, the VD of the deep capillary plexuses (DCP) was significantly greater in the external controls than cases and internal controls (P= .029). The average FAZ area was 0.26 ± 0.06 mm2 in amblyopic eyes that was significantly higher compared with fellow eyes (0.21 ± 0.07 mm2; P= .022), but it was not different with non-amblyopic eyes (0.22 ± 0.118 mm2). Based on our findings, there were no significant difference in the cases of foveal, parafoveal, and perifoveal in both superficial and deep vascular densities among amblyopic and non-amblyopic eyes, whereas deep whole density of the amblyopic eyes showed lower percent compared to non-amblyopic ones that indicates decrease blood supply of the amblyopic eyes in this region. Additionally, FAZ was larger in amblyopic eyes than internal controls.
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Affiliation(s)
- Ramin Nourinia
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences,Tehran, Iran
| | - Zhale Rajavi
- Negah Aref Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Ophthalmic Epidemiology Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamideh Sabbaghi
- Ophthalmic Epidemiology Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kiana Hassanpour
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences,Tehran, Iran.,Department of Ophthalmology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Ahmadieh
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences,Tehran, Iran
| | - Bahareh Kheiri
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences,Tehran, Iran
| | - Mojtaba Rajabpour
- Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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21
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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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22
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Xiao Y, Shi K, Li C, Yang K, Zhu X, Su B, Ju Y, Lu F, Qu J, Li M, Cui L. Association of self-reported snoring with decreased retinal thickness and vessel density. Front Physiol 2022; 13:917808. [PMID: 35991162 PMCID: PMC9388747 DOI: 10.3389/fphys.2022.917808] [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: 04/11/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose: Self-reported snoring has been reported to influence nerves and vessels. However, there are few direct evidences of snoring related to nerves and microvessels defects. Therefore, we evaluated the association of self-reported snoring with retinal structure and microcirculation.Methods: A total of 2,622 participants were recruited from the Jidong eye cohort study (JECS). Physical examinations, laboratory tests, and questionnaires were recorded. We also used optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) to assess the retinal structure and microvascular network. Snoring was defined as “never,” “occasionally,” and “frequently or more severe” according to self-reported frequency.Results: The prevalence of snoring were 84.6% (n = 983) and 45.0% (n = 657) in males and females, respectively. Compared with never snoring group, the retinal thickness increased in “occasionally” (p < 0.001) and “frequently or more severe” groups (p = 0.001), while no difference was found between snoring groups (p = 0.14). Superficial retinal capillary plexus (RCP) vessel density was lower in “frequently or more severe” group than in “never” (p < 0.001) and “occasionally” snoring groups (p < 0.001). After adjusting for confounders, “frequently or more severe” snoring was significantly associated with thinner total retinal thickness [β = −2.79 (95% CI: −5.27, −0.30)] and lower superficial RCP vessel density [β = −0.71 (95% CI: −1.19, −0.23)].Conclusion: Our research showed self-reported snoring was associated with thinner retinal thickness and lower superficial RCP vessel density. The findings of our study emphasize the need for self-reported snoring assessments in determining retinal structure and microcirculation impairment.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jia Qu
- *Correspondence: Jia Qu, ; Ming Li, ; Lele Cui,
| | - Ming Li
- *Correspondence: Jia Qu, ; Ming Li, ; Lele Cui,
| | - Lele Cui
- *Correspondence: Jia Qu, ; Ming Li, ; Lele Cui,
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Cheung CMG, Fawzi A, Teo KY, Fukuyama H, Sen S, Tsai WS, Sivaprasad S. Diabetic macular ischaemia- a new therapeutic target? Prog Retin Eye Res 2022; 89:101033. [PMID: 34902545 PMCID: PMC11268431 DOI: 10.1016/j.preteyeres.2021.101033] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 11/25/2021] [Accepted: 12/01/2021] [Indexed: 12/21/2022]
Abstract
Diabetic macular ischaemia (DMI) is traditionally defined and graded based on the angiographic evidence of an enlarged and irregular foveal avascular zone. However, these anatomical changes are not surrogate markers for visual impairment. We postulate that there are vascular phenotypes of DMI based on the relative perfusion deficits of various retinal capillary plexuses and choriocapillaris. This review highlights several mechanistic pathways, including the role of hypoxia and the complex relation between neurons, glia, and microvasculature. The current animal models are reviewed, with shortcomings noted. Therefore, utilising the advancing technology of optical coherence tomography angiography (OCTA) to identify the reversible DMI phenotypes may be the key to successful therapeutic interventions for DMI. However, there is a need to standardise the nomenclature of OCTA perfusion status. Visual acuity is not an ideal endpoint for DMI clinical trials. New trial endpoints that represent disease progression need to be developed before irreversible vision loss in patients with DMI. Natural history studies are required to determine the course of each vascular and neuronal parameter to define the DMI phenotypes. These DMI phenotypes may also partly explain the development and recurrence of diabetic macular oedema. It is also currently unclear where and how DMI fits into the diabetic retinopathy severity scales, further highlighting the need to better define the progression of diabetic retinopathy and DMI based on both multimodal imaging and visual function. Finally, we discuss a complete set of proposed therapeutic pathways for DMI, including cell-based therapies that may provide restorative potential.
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Affiliation(s)
- Chui Ming Gemmy Cheung
- Singapore Eye Research Institution, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | | | - Kelvin Yc Teo
- Singapore Eye Research Institution, Singapore National Eye Centre, Singapore
| | | | | | - Wei-Shan Tsai
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, United Kingdom
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, United Kingdom.
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24
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Hunt M, Wylęgała A, Wylęgała E, Teper S. 1-Year Fixed-Regimen Bevacizumab Treatment in DME-Vascular Network Image Analysis in Optical Coherence Tomography Angiography Study. J Clin Med 2022; 11:2125. [PMID: 35456217 PMCID: PMC9029661 DOI: 10.3390/jcm11082125] [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: 03/01/2022] [Revised: 03/25/2022] [Accepted: 04/06/2022] [Indexed: 12/05/2022] Open
Abstract
PURPOSE To evaluate the effectiveness of intravitreal bevacizumab treatment in patients with diabetic macular edema (DME) by assessing retinal changes using AngioTool software (version 0.6a(02.18.14), National Cancer Institute, Bethesda, Maryland). METHODS A total of 27 eyes in patients with treatment-naïve DME were included in this prospective study. OCT-A images with a scan area of 6 × 6 mm were obtained. 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) and CMT, were assessed. Explant area, vessels area, vessels percentage area, total number of junctions, total vessels length, average vessels length, the total number of endpoints, and mean lacunarity in the superficial capillary plexus (SCP) were calculated by using AngioTool software. RESULTS Twenty-nine eyes of DME patients were subjected to the final analysis. Bevacizumab treatment reduced CMT from 401.84 ± 84.54 µm to 328.93 ± 87.17 µm and improved BCVA from 65.18 ± 8.21 at baseline to 72.63 ± 7.43 letters among participants of the study. The anti-VEGF therapy showed no statistically significant changes in parameters calculated by AngioTool software in the study group of patients. CONCLUSION The fixed-regimen intravitreal bevacizumab therapy was effective in treating DME. AngioTool software is an additional tool that could be used to assess vascular networks. However, the use of OCTA is unlikely to alter DME treatment regimens significantly or to find significant predictors. Perhaps using wide-angle devices or software will give a complete picture of the disease and prove to be more helpful.
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Affiliation(s)
- Magdalena Hunt
- Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-760 Katowice, Poland; (E.W.); (S.T.)
- 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, 40-760 Katowice, Poland;
| | - Edward Wylęgała
- Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-760 Katowice, Poland; (E.W.); (S.T.)
- Department of Ophthalmology, District Railway Hospital in Katowice, 40-760 Katowice, Poland
| | - Sławomir Teper
- Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-760 Katowice, Poland; (E.W.); (S.T.)
- Department of Ophthalmology, District Railway Hospital in Katowice, 40-760 Katowice, Poland
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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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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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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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Cordón B, Orduna-Hospital E, Viladés E, Garcia-Martin E, Garcia-Campayo J, Puebla-Guedea M, Polo V, Larrosa JM, Pablo LE, Vicente MJ, Satue M. Analysis of Retinal Layers in Fibromyalgia Patients with Premium Protocol in Optical Tomography Coherence and Quality of Life. Curr Eye Res 2021; 47:143-153. [PMID: 34213409 DOI: 10.1080/02713683.2021.1951301] [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: 10/20/2022]
Abstract
PURPOSE To evaluate the inner retinal layers in fibromyalgia (FM) patients compared to control subjects using posterior pole protocol (PPole) analysis in optical coherence tomography (OCT) and to correlate structural retinal changes with subjective quality of life. METHODS Seventy-four eyes of healthy subjects and 55 eyes of those with FM were analyzed. All subjects underwent retinal evaluation using the PPole protocol for Spectralis OCT (Heidelberg Engineering) to obtain measurements of the retinal nerve fiber layer (RNFL) and the ganglion cell layer (GCL) in the macular area. The EuroQol (EQ-5D) questionnaire and Fibromyalgia Impact Questionnaire (FIQ) were performed to analyze health-related quality of life. Additionally, the FM group was divided into three groups depending on the disease phenotype (atypical, depressive and biological). RESULTS : Patients with FM presented with a reduction of the RNFL thickness compared to controls in 17/64 cells of the PPole area, and a reduction of the GCL thickness in 47/64 cells. Depressive FM phenotype showed the greatest number of cells with significant reduction compared with the control group in both RNFL and GCL layers. A correlation between temporal-inferior cells of the GCL and the EuroQol 5D questionnaire results was observed. CONCLUSIONS Patients with FM present with a reduction of the inner retinal layers in the macular area. This degeneration correlates with disease severity/reduced quality of life in these patients. The PPole protocol for OCT is a non-invasive and fast tool that might help clinicians diagnose and monitor neurodegeneration in FM patients.
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Affiliation(s)
- B Cordón
- Miguel Servet Ophthalmology Research and Innovative Group (GIMSO). Aragon Institute for Health Research (IIS Aragón). University of Zaragoza. Zaragoza (Spain).,Ophthalmology Department, Miguel Servet University Hospital. Zaragoza (Spain)
| | - E Orduna-Hospital
- Miguel Servet Ophthalmology Research and Innovative Group (GIMSO). Aragon Institute for Health Research (IIS Aragón). University of Zaragoza. Zaragoza (Spain).,Ophthalmology Department, Miguel Servet University Hospital. Zaragoza (Spain)
| | - E Viladés
- Miguel Servet Ophthalmology Research and Innovative Group (GIMSO). Aragon Institute for Health Research (IIS Aragón). University of Zaragoza. Zaragoza (Spain).,Ophthalmology Department, Miguel Servet University Hospital. Zaragoza (Spain)
| | - E Garcia-Martin
- Miguel Servet Ophthalmology Research and Innovative Group (GIMSO). Aragon Institute for Health Research (IIS Aragón). University of Zaragoza. Zaragoza (Spain).,Ophthalmology Department, Miguel Servet University Hospital. Zaragoza (Spain)
| | - J Garcia-Campayo
- Ophthalmology Department, Miguel Servet University Hospital. Zaragoza (Spain).,Psychiatry Department, Miguel Servet University Hospital, Zaragoza, Spain
| | - M Puebla-Guedea
- Aragon Institute for Health Research (IIS Aragón). University of Zaragoza. Zaragoza (Spain)
| | - V Polo
- Miguel Servet Ophthalmology Research and Innovative Group (GIMSO). Aragon Institute for Health Research (IIS Aragón). University of Zaragoza. Zaragoza (Spain).,Ophthalmology Department, Miguel Servet University Hospital. Zaragoza (Spain)
| | - J M Larrosa
- Miguel Servet Ophthalmology Research and Innovative Group (GIMSO). Aragon Institute for Health Research (IIS Aragón). University of Zaragoza. Zaragoza (Spain).,Ophthalmology Department, Miguel Servet University Hospital. Zaragoza (Spain)
| | - L E Pablo
- Miguel Servet Ophthalmology Research and Innovative Group (GIMSO). Aragon Institute for Health Research (IIS Aragón). University of Zaragoza. Zaragoza (Spain).,Ophthalmology Department, Miguel Servet University Hospital. Zaragoza (Spain)
| | - M J Vicente
- Miguel Servet Ophthalmology Research and Innovative Group (GIMSO). Aragon Institute for Health Research (IIS Aragón). University of Zaragoza. Zaragoza (Spain).,Ophthalmology Department, Miguel Servet University Hospital. Zaragoza (Spain)
| | - M Satue
- Miguel Servet Ophthalmology Research and Innovative Group (GIMSO). Aragon Institute for Health Research (IIS Aragón). University of Zaragoza. Zaragoza (Spain).,Ophthalmology Department, Miguel Servet University Hospital. Zaragoza (Spain)
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Guo M, Zhao M, Cheong AMY, Corvi F, Chen X, Chen S, Zhou Y, Lam AKC. Can deep learning improve the automatic segmentation of deep foveal avascular zone in optical coherence tomography angiography? Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.102456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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30
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Orduna-Hospital E, Cordón B, Vilades E, Garcia-Martin E, Garcia-Campayo J, López-Del-Hoyo Y, Polo V, Larrosa JM, Pablo LE, Satue M. Ganglion Cell and Retinal Nerve Fiver Layers Correlated with Time Disease of Bipolar Disorder Using 64 Cell Grid OCT Tool. Curr Eye Res 2021; 46:1214-1222. [PMID: 33455447 DOI: 10.1080/02713683.2021.1877313] [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: 10/22/2022]
Abstract
MATERIALS AND METHODS Twenty-five eyes of 25 patients with bipolar disorder and 74 eyes of 74 healthy controls underwent retinal measurements of retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL) thickness. Measurements were obtained using the Spectralis-OCT device with the new Posterior Pole protocol which assesses the macular area by analyzing retinal thickness in a grid of 64 (8*8) cells. RESULTS Significant differences (p < 0.05) in RNFL and GCL thickness were found between BD patients and healthy controls, in parafoveal and perifoveal cells respectively. Significant inverse correlations were found between RNFL and GCL thinning at their thickest location and the duration of bipolar disorder. Several predictive variables were observed with a binary logistic regression for the presence/absence of BD: cell 1.3 RNFL (p = 0.028) and GCL in cells 7.8 (p = 0.012), 2.7 (p = 0.043) and 1.3 (p = 0.047). CONCLUSION Posterior Pole OCT protocol is a useful tool to assess changes in the inner retinal layers in bipolar disorder. These observed changes, especially those affecting the GCL, may be associated with disease evolution and may be predictive of the presence of the disease. OCT data could potentially be a useful tool for clinicians to diagnose and monitor BD patients.
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Affiliation(s)
- Elvira Orduna-Hospital
- Miguel Servet Ophthalmology Research and Innovative Group (GIMSO), Aragon Institute for Health Research (IIS Aragón), University of Zaragoza, Zaragoza, Spain.,Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain
| | - Beatriz Cordón
- Miguel Servet Ophthalmology Research and Innovative Group (GIMSO), Aragon Institute for Health Research (IIS Aragón), University of Zaragoza, Zaragoza, Spain.,Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain
| | - Elisa Vilades
- Miguel Servet Ophthalmology Research and Innovative Group (GIMSO), Aragon Institute for Health Research (IIS Aragón), University of Zaragoza, Zaragoza, Spain.,Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain
| | - Elena Garcia-Martin
- Miguel Servet Ophthalmology Research and Innovative Group (GIMSO), Aragon Institute for Health Research (IIS Aragón), University of Zaragoza, Zaragoza, Spain.,Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain
| | | | - Yolanda López-Del-Hoyo
- Aragon Institute for Health Research (IIS Aragón), University of Zaragoza, Zaragoza, Spain
| | - Vicente Polo
- Miguel Servet Ophthalmology Research and Innovative Group (GIMSO), Aragon Institute for Health Research (IIS Aragón), University of Zaragoza, Zaragoza, Spain.,Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain
| | - Jose M Larrosa
- Miguel Servet Ophthalmology Research and Innovative Group (GIMSO), Aragon Institute for Health Research (IIS Aragón), University of Zaragoza, Zaragoza, Spain.,Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain
| | - Luis E Pablo
- Miguel Servet Ophthalmology Research and Innovative Group (GIMSO), Aragon Institute for Health Research (IIS Aragón), University of Zaragoza, Zaragoza, Spain.,Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain
| | - Maria Satue
- Miguel Servet Ophthalmology Research and Innovative Group (GIMSO), Aragon Institute for Health Research (IIS Aragón), University of Zaragoza, Zaragoza, Spain.,Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain
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31
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Carreira AR, Cardoso J, Lopes D, Loureiro T, Sampaio A, Fonseca T, Vide-Escada A, Campos N. Long-term macular vascular density measured by OCT-A in children with retinopathy of prematurity with and without need of laser treatment. Eur J Ophthalmol 2020; 31:3337-3341. [PMID: 33372558 DOI: 10.1177/1120672120983204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess long-term vascular density measured by optical coherence tomography angiography (OCT-A) in former preterm children with history of retinopathy of prematurity (ROP) with and without need of laser treatment. METHODS This observational study included former preterm children that developed ROP stage 2 or 3. Infants were divided in two groups according to previous need of laser treatment, and underwent a complete ophthalmologic evaluation, including assessment of macular morphologic and vascular parameters by OCT-A. RESULTS Fifteen eyes were included in group 1 (laser-requiring ROP) and 19 in group 2 (non-treated ROP). Group 1 had lower mean gestational age and birth weight values than group 2 (p < 0.001 and p < 0.001, respectively). Best corrected visual acuity (BCVA) was lower in group 1 (0.08 ± 0.04 logMAR vs 0.04 ± 0.07 logMAR, p = 0.03). Laser-requiring ROP had lower vascular parameters, especially of central and internal vascular density (9.15 ± 2.75 vs 10.52 ± 0.86 mm-1, p = 0.05; 13.74 ± 1.00 vs 15.86 ± 0.64 mm-1, p = 0.05; respectively), and lower avascular zone circularity (0.58 ± 0.06 vs 0.76 ± 0.02, p < 0.001). Mean macular thickness was higher in group 1 (300.50 ± 10.50 vs 281.11 ± 2.50 μm, p = 0.05). Best corrected visual acuity (BCVA) was correlated with superficial vascular density (p < 0.05). CONCLUSION Laser-requiring ROP seems to result in a decrease of long-term BCVA, which is at least partially attributed to a decrease in superficial macular vascular density. However, prematurity degree was more pronounced in children that required treatment, which might have influenced our results.
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Affiliation(s)
- Ana Rita Carreira
- Ophthalmology Department of Hospital Garcia de Orta EPE, Almada, Portugal
| | - João Cardoso
- Ophthalmology Department of Hospital Garcia de Orta EPE, Almada, Portugal
| | - Diogo Lopes
- Ophthalmology Department of Hospital Garcia de Orta EPE, Almada, Portugal
| | - Tomás Loureiro
- Ophthalmology Department of Hospital Garcia de Orta EPE, Almada, Portugal
| | - Audrey Sampaio
- Ophthalmology Department of Hospital Garcia de Orta EPE, Almada, Portugal
| | - Teresa Fonseca
- Ophthalmology Department of Hospital Garcia de Orta EPE, Almada, Portugal
| | - Ana Vide-Escada
- Ophthalmology Department of Hospital Garcia de Orta EPE, Almada, Portugal
| | - Nuno Campos
- Ophthalmology Department of Hospital Garcia de Orta EPE, Almada, Portugal
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Cordon B, Vilades E, Orduna E, Satue M, Perez-Velilla J, Sebastian B, Polo V, Larrosa JM, Pablo LE, Garcia-Martin E. Angiography with optical coherence tomography as a biomarker in multiple sclerosis. PLoS One 2020; 15:e0243236. [PMID: 33290417 PMCID: PMC7723290 DOI: 10.1371/journal.pone.0243236] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 11/18/2020] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To investigate superficial retinal microvascular plexuses detected by optical coherence tomography angiography (OCT-A) in multiple sclerosis (MS) subjects and compare them with healthy controls. METHODS A total of 92 eyes from 92 patients with relapsing-remitting MS and 149 control eyes were included in this prospective observational study. OCT-A imaging was performed using Triton Swept-Source OCT (Topcon Corporation, Japan). The vessel density (VD) percentage in the superficial retinal plexus and optic disc area (6 x 6 mm grid) was measured and compared between groups. RESULTS MS patients showed a significant decrease VD in the superior (p = 0.005), nasal (p = 0.029) and inferior (p = 0.040) parafoveal retina compared with healthy subjects. Patients with disease durations of more than 5 years presented lower VD in the superior (p = 0.002), nasal (p = 0.017) and inferior (p = 0.022) parafoveal areas compared with healthy subjects. Patients with past optic neuritis episodes did not show retinal microvasculature alterations, but patients with an EDSS score of less than 3 showed a significant decrease in nasal (p = 0.024) and superior (p = 0.006) perifoveal VD when compared with healthy subjects. CONCLUSIONS MS produces a decrease in retinal vascularization density in the superficial plexus of the parafoveal retina. Alterations in retinal vascularization observed in MS patients are independent of the presence of optic nerve inflammation. OCT-A has the ability to detect subclinical vascular changes and is a potential biomarker for diagnosing the presence and progression of MS.
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Affiliation(s)
- Beatriz Cordon
- Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain
- Miguel Servet Ophthalmology Innovation and Research Group (GIMSO), Aragon Institute for Health Research (IIS Aragon), University of Zaragoza, Zaragoza, Spain
- * E-mail:
| | - Elisa Vilades
- Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain
- Miguel Servet Ophthalmology Innovation and Research Group (GIMSO), Aragon Institute for Health Research (IIS Aragon), University of Zaragoza, Zaragoza, Spain
| | - Elvira Orduna
- Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain
- Miguel Servet Ophthalmology Innovation and Research Group (GIMSO), Aragon Institute for Health Research (IIS Aragon), University of Zaragoza, Zaragoza, Spain
| | - María Satue
- Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain
- Miguel Servet Ophthalmology Innovation and Research Group (GIMSO), Aragon Institute for Health Research (IIS Aragon), University of Zaragoza, Zaragoza, Spain
| | - Javier Perez-Velilla
- Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain
- Miguel Servet Ophthalmology Innovation and Research Group (GIMSO), Aragon Institute for Health Research (IIS Aragon), University of Zaragoza, Zaragoza, Spain
| | - Berta Sebastian
- National Ocular Pathology Network (OFTARED) at the Carlos III Institute of Health, Madrid, Spain
| | - Vicente Polo
- Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain
- Miguel Servet Ophthalmology Innovation and Research Group (GIMSO), Aragon Institute for Health Research (IIS Aragon), University of Zaragoza, Zaragoza, Spain
- Neurology Department, Miguel Servet University Hospital, Zaragoza, Spain
| | - Jose Manuel Larrosa
- Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain
- Miguel Servet Ophthalmology Innovation and Research Group (GIMSO), Aragon Institute for Health Research (IIS Aragon), University of Zaragoza, Zaragoza, Spain
- Neurology Department, Miguel Servet University Hospital, Zaragoza, Spain
| | - Luis Emilio Pablo
- Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain
- Miguel Servet Ophthalmology Innovation and Research Group (GIMSO), Aragon Institute for Health Research (IIS Aragon), University of Zaragoza, Zaragoza, Spain
- Neurology Department, Miguel Servet University Hospital, Zaragoza, Spain
| | - Elena Garcia-Martin
- Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain
- Miguel Servet Ophthalmology Innovation and Research Group (GIMSO), Aragon Institute for Health Research (IIS Aragon), University of Zaragoza, Zaragoza, Spain
- Neurology Department, Miguel Servet University Hospital, Zaragoza, Spain
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Told R, Georgopoulos M, Reiter GS, Wassermann L, Aliyeva L, Baumann L, Abela-Formanek C, Pollreisz A, Schmidt-Erfurth U, Sacu S. Intraretinal microvascular changes after ERM and ILM peeling using SSOCTA. PLoS One 2020; 15:e0242667. [PMID: 33259500 PMCID: PMC7707569 DOI: 10.1371/journal.pone.0242667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 11/06/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND To prospectively investigate retinal vascular changes in patients undergoing epiretinal membrane (ERM) and internal limiting membrane (ILM) peeling using swept source optical coherence tomography angiography (SSOCTA). METHODS Consecutive patients were grouped based on ERM severity and followed using SSOCTA up to month 3 after surgical intervention. Superficial and deep foveal avascular zone (s/dFAZ) as well as foveal and parafoveal vessel density (VD) were correlated with ERM severity and visual acuity. Differences between groups were evaluated. RESULTS Significant correlations were found between ERM severity and baseline sFAZ, dFAZ and best corrected visual acuity (BCVA), central retinal subfield thickness (CST) and ΔCST (r = -0.52, r = -0.43, r = -0.42, r = 0.58, r = 0.39; all p<0.05). Vascular flow parameters did not correlate with age, peeling size, pseudophakia or CST, but correlated with intraretinal cysts presence. No associations of BCVA with any of the OCTA parameters across time were found. Significant differences between ERM severity groups 1 and 2 were found for sFAZ at baseline (p = 0.005) and at the 3-month follow-up (p = 0.014), and for dFAZ at baseline (p = 0.017). Superficial foveal and parafoveal VD were not significantly different between groups (all p>0.05). CONCLUSIONS This study clearly shows that ERM severity based on ERM staging has to be taken into account when undertaking studies in patients with idiopathic ERM using SSOCTA. Further, specific changes in the superficial and deep retinal vasculature in eyes undergoing ERM and ILM peeling were found. However, the clinical usefulness and prognostic value for post-surgical treatment BCVA of the SSOCTA-derived variables (sFAZ and dFAZ area, as well as foveal and parafoveal VD) used remains questionable.
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Affiliation(s)
- Reinhard Told
- Department of Ophthalmology and Optometry, Vienna Trial Center (VTC), Medical University of Vienna, Vienna, Austria
| | - Michael Georgopoulos
- Department of Ophthalmology and Optometry, Vienna Trial Center (VTC), Medical University of Vienna, Vienna, Austria
| | - Gregor Sebastian Reiter
- Department of Ophthalmology and Optometry, Vienna Trial Center (VTC), Medical University of Vienna, Vienna, Austria
| | - Lorenz Wassermann
- Department of Ophthalmology and Optometry, Vienna Trial Center (VTC), Medical University of Vienna, Vienna, Austria
| | - Leyla Aliyeva
- Department of Ophthalmology and Optometry, Vienna Trial Center (VTC), Medical University of Vienna, Vienna, Austria
| | - Lukas Baumann
- Department of Medical Statistics Vienna, Medical University of Vienna, Vienna, Austria
| | - Claudette Abela-Formanek
- Department of Ophthalmology and Optometry, Vienna Trial Center (VTC), Medical University of Vienna, Vienna, Austria
| | - Andreas Pollreisz
- Department of Ophthalmology and Optometry, Vienna Trial Center (VTC), Medical University of Vienna, Vienna, Austria
| | - Ursula Schmidt-Erfurth
- Department of Ophthalmology and Optometry, Vienna Trial Center (VTC), Medical University of Vienna, Vienna, Austria
| | - Stefan Sacu
- Department of Ophthalmology and Optometry, Vienna Trial Center (VTC), Medical University of Vienna, Vienna, Austria
- * E-mail:
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Optical coherence tomography angiography in diabetic retinopathy: an updated review. Eye (Lond) 2020; 35:149-161. [PMID: 33099579 DOI: 10.1038/s41433-020-01233-y] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/27/2020] [Accepted: 10/15/2020] [Indexed: 12/17/2022] Open
Abstract
Diabetic retinopathy (DR) is a common microvascular complication of diabetes mellitus. Optical coherence tomography angiography (OCTA) has been developed to visualize the retinal microvasculature and choriocapillaris based on the motion contrast of circulating blood cells. Depth-resolved ability and non-invasive nature of OCTA allow for repeated examinations and visualization of microvasculature at the retinal capillary plexuses and choriocapillaris. OCTA enables quantification of microvascular alterations in the retinal capillary network, in addition to the detection of classical features associated with DR, including microaneurysms, intraretinal microvascular abnormalities, and neovascularization. OCTA has a promising role as an objective tool for quantifying extent of microvascular damage and identify eyes with diabetic macular ischaemia contributed to visual loss. Furthermore, OCTA can identify preclinical microvascular abnormalities preceding the onset of clinically detectable DR. In this review, we focused on the applications of OCTA derived quantitative metrics that are relevant to early detection, staging and progression of DR. Advancement of OCTA technology in clinical research will ultimately lead to enhancement of individualised management of DR and prevention of visual impairment in patients with diabetes.
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Gunzenhauser RC, Tsui I, Velez FG, Fung SS, Demer JL, Suh SY, Sarraf D, Pineles SL. Comparison of Pre-Treatment vs. Post-Treatment Retinal Vessel Density in Children with Amblyopia. J Binocul Vis Ocul Motil 2020; 70:79-85. [PMID: 32412887 DOI: 10.1080/2576117x.2020.1760695] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Prior studies have reported a lower retinal vessel density (RVD) in amblyopic vs. non-amblyopic eyes. No studies have shown if amblyopic eye RVD changes following patching therapy. We assessed for RVD differences between pre-treatment vs. post-treatment amblyopic eyes. METHODS Participants were included if they were <10 years old with unilateral amblyopia. All subjects were required to visit the pediatric eye clinic for examination. Exclusion criteria included: deprivation amblyopia, bilateral amblyopia, nystagmus, media opacity, intraocular inflammation, or any retinal disease. All participants underwent optical coherence tomography angiography (OCTA) before and after refraction and patching treatment. Outcomes included superficial (SCP) and deep (DCP) capillary plexus RVD. RESULTS 12 patients (12 amblyopic eyes) were included. Mean (SD) age, gestational age (GA), birth weight (BW), and follow-up time were: 6.5 (1.7) years, 39.4 weeks (1.4 w), 3271 g (262 g), and 114 days (46d), respectively. There was a significant increase in the RVD of the DCP in 3 × 3-mm scans after treatment, specifically in the whole image (52.6 ± 5.75 vs 56.5 ± 2.48%, p = .046) and superior hemisphere regions (52.47 ± 6.17 vs 56.73 ± 2.27%, p = .048). CONCLUSIONS Amblyopic eye RVD potentially increases after amblyopia treatment in specific regions of the retina. Further research is required to refine this clinical parameter.
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Affiliation(s)
- Robert C Gunzenhauser
- Department of Ophthalmology, Stein Eye Institute, University of California , Los Angeles, California
| | - Irena Tsui
- Department of Ophthalmology, Stein Eye Institute, University of California , Los Angeles, California.,Department of Ophthalmology, Doheny Eye Institute, University of California , Los Angeles, California
| | - Federico G Velez
- Department of Ophthalmology, Doheny Eye Institute, University of California , Los Angeles, California.,Department of Ophthalmology, Duke University Eye Center, Duke University , Durham, North Carolina
| | - Simon Sm Fung
- Department of Ophthalmology, Stein Eye Institute, University of California , Los Angeles, California
| | - Joseph L Demer
- Department of Ophthalmology, Stein Eye Institute, University of California , Los Angeles, California
| | - Soh Y Suh
- Department of Ophthalmology, Stein Eye Institute, University of California , Los Angeles, California
| | - David Sarraf
- Department of Ophthalmology, Stein Eye Institute, University of California , Los Angeles, California
| | - Stacy L Pineles
- Department of Ophthalmology, Stein Eye Institute, University of California , Los Angeles, California
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Suciu CI, Suciu VI, Nicoara SD. Optical Coherence Tomography (Angiography) Biomarkers in the Assessment and Monitoring of Diabetic Macular Edema. J Diabetes Res 2020; 2020:6655021. [PMID: 33490283 PMCID: PMC7790580 DOI: 10.1155/2020/6655021] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 12/02/2022] Open
Abstract
Retinopathy is one of the most severe diabetes-related complications, and macular edema is the major cause of central vision loss in patients with diabetes mellitus. Significant progress has been made in recent years in optical coherence tomography and angiography technology. At the same time, various parameters have been attributed the role of biomarkers creating the frame for new monitoring and treatment strategies and offering new insights into the pathogenesis of diabetic retinopathy and diabetic macular edema. In this review, we gathered the results of studies that investigated various specific OCT (angiography) parameters in diabetic macular edema, such as central subfoveal thickness (CST), cube average thickness (CAT), cube volume (CV), choroidal thickness (CT), retinal nerve fiber layer (RNFL), retinal thickness at the fovea (RTF), subfoveal choroidal thickness (SFCT), central macular thickness (CMT), choroidal vascularity index (CVI), total macular volume (TMV), central choroid thickness (CCT), photoreceptor outer segment (PROS), perfused capillary density (PCD), foveal avascular zone (FAZ), subfoveal neuroretinal detachment (SND), hyperreflective foci (HF), disorganization of the inner retinal layers (DRIL), ellipsoid zone (EZ), inner segment/outer segment (IS/OS) junctions, vascular density (VD), deep capillary plexus (DCP), and superficial capillary plexus (SCP), in order to provide a synthesis of biomarkers that are currently used for the early diagnosis, assessment, monitoring, and outlining of prognosis.
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Affiliation(s)
| | - Vlad-Ioan Suciu
- Medical Doctoral School, “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca 400012, Romania
| | - Simona-Delia Nicoara
- Medical Doctoral School, University of Oradea, Oradea 410087, Romania
- Department of Ophthalmology, “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca 400012, Romania
- Emergency County Hospital, Cluj-Napoca 400006, Romania
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