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Rui Y, Zhang M, Lee DM, Snyder VC, Raghuraman R, Gofas-Salas E, Mecê P, Yadav S, Tiruveedhula P, Grieve K, Sahel JA, Errera MH, Rossi EA. Label-Free Imaging of Inflammation at the Level of Single Cells in the Living Human Eye. OPHTHALMOLOGY SCIENCE 2024; 4:100475. [PMID: 38881602 PMCID: PMC11179426 DOI: 10.1016/j.xops.2024.100475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 12/22/2023] [Accepted: 01/16/2024] [Indexed: 06/18/2024]
Abstract
Purpose Putative microglia were recently detected using adaptive optics ophthalmoscopy in healthy eyes. Here we evaluate the use of nonconfocal adaptive optics scanning light ophthalmoscopy (AOSLO) for quantifying the morphology and motility of presumed microglia and other immune cells in eyes with retinal inflammation from uveitis and healthy eyes. Design Observational exploratory study. Participants Twelve participants were imaged, including 8 healthy participants and 4 posterior uveitis patients recruited from the clinic of 1 of the authors (M.H.E.). Methods The Pittsburgh AOSLO imaging system was used with a custom-designed 7-fiber optical fiber bundle for simultaneous confocal and nonconfocal multioffset detection. The inner retina was imaged at several locations at multiple timepoints in healthy participants and uveitis patients to generate time-lapse images. Main Outcome Measures Microglia and macrophages were manually segmented from nonconfocal AOSLO images, and their morphological characteristics quantified (including soma size, diameter, and circularity). Cell soma motion was quantified across time for periods of up to 30 minutes and their speeds were calculated by measuring their displacement over time. Results A spectrum of cell morphologies was detected in healthy eyes from circular amoeboid cells to elongated cells with visible processes, resembling activated and ramified microglia, respectively. Average soma diameter was 16.1 ± 0.9 μm. Cell movement was slow in healthy eyes (0.02 μm/sec on average), but macrophage-like cells moved rapidly in some uveitis patients (up to 3 μm/sec). In an eye with infectious uveitis, many macrophage-like cells were detected; during treatment their quantity and motility decreased as vision improved. Conclusions In vivo adaptive optics ophthalmoscopy offers promise as a potentially powerful tool for detecting and monitoring inflammation and response to treatment at a cellular level in the living eye. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Yuhua Rui
- Department of Ophthalmology, University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania
- Eye Center of Xiangya Hospital, Central South University Hunan Key Laboratory of Ophthalmology Changsha, Hunan, China
| | - Min Zhang
- Department of Ophthalmology, University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania
| | - Daniel M.W. Lee
- Department of Bioengineering, University of Pittsburgh Swanson School of Engineering Pittsburgh, Pennsylvania
| | - Valerie C. Snyder
- Department of Ophthalmology, University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania
| | - Rashmi Raghuraman
- Department of Ophthalmology, University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania
| | - Elena Gofas-Salas
- Sorbonne Université, INSERM, CNRS, Institut de la Vision, Paris, France
- CHNO des Quinze-Vingts, INSERM-DGOS CIC 1423, Paris, France
| | - Pedro Mecê
- Institut Langevin, ESPCI Paris, Université PSL, CNRS, Paris, France
| | - Sanya Yadav
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Kate Grieve
- Sorbonne Université, INSERM, CNRS, Institut de la Vision, Paris, France
- CHNO des Quinze-Vingts, INSERM-DGOS CIC 1423, Paris, France
| | - José-Alain Sahel
- Department of Ophthalmology, University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania
| | - Marie-Hélène Errera
- Department of Ophthalmology, University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania
| | - Ethan A. Rossi
- Department of Ophthalmology, University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania
- Department of Bioengineering, University of Pittsburgh Swanson School of Engineering Pittsburgh, Pennsylvania
- McGowan Institute for Regenerative Medicine Pittsburgh, Pennsylvania
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Graven-Nielsen M, Dubra A, Dodd RL, Hamann S, Moss HE. Application of novel non-invasive ophthalmic imaging to visualize peripapillary wrinkles, retinal folds and peripapillary hyperreflective ovoid mass-like structures associated with elevated intracranial pressure. Front Neurol 2024; 15:1383210. [PMID: 38957348 PMCID: PMC11217179 DOI: 10.3389/fneur.2024.1383210] [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: 02/07/2024] [Accepted: 05/13/2024] [Indexed: 07/04/2024] Open
Abstract
Background Elevated intracranial pressure (ICP) is a serious and potentially life-threatening condition, for which clinically useful non-invasive measures have been elusive, in some cases due to their inadequate sensitivity and specificity. Our aim was to evaluate novel non-invasive ophthalmic imaging of selected pathological features seen in elevated ICP, namely peripapillary hyperreflective ovoid mass-like structures (PHOMS), peripapillary wrinkles (PPW) and retinal folds (RF) as potential biomarkers of elevated ICP. Methods This single-center pilot study included subjects with untreated or incompletely treated high ICP. The retinas of these subjects were evaluated with averaged en-face optical coherence tomography (OCT), OCT retinal cross-sections (OCT B-scans), adaptive optics scanning light ophthalmoscopy (AOSLO), and fundus photos. Results Seven subjects were included in the study. 6 subjects with high ICP (5 idiopathic intracranial hypertension, 1 medication induced, 30.8 ± 8.6 years, 75% female, 5 with papilledema) and 1 control (20-25 years) were included. PHOMS, PPW and RF were present in all subjects with papilledema, but neither in the high ICP subject without papilledema nor in the control subject. Averaged en-face OCT scans and AOSLO were more sensitive for PPW and RF than OCT B-scans and commercial fundus photos. Conclusion PPW, RF and PHOMS volume have potential as non-invasive biomarkers of ICP. Novel imaging modalities may improve sensitivity. However, lack of automated image acquisition and processing limits current widespread adoption in clinical settings. Further research is needed to validate these structures as biomarkers for elevated ICP and improve clinical utility.
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Affiliation(s)
- Michaela Graven-Nielsen
- Department of Ophthalmology, Stanford University, Palo Alto, CA, United States
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
| | - Alfredo Dubra
- Department of Ophthalmology, Stanford University, Palo Alto, CA, United States
| | - Robert L. Dodd
- Department of Neurosurgery, Stanford University, Palo Alto, CA, United States
| | - Steffen Hamann
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Heather E. Moss
- Department of Ophthalmology, Stanford University, Palo Alto, CA, United States
- Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, CA, United States
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de Guimaraes TAC, Lai F, Colombatti R, Sato G, Rizzo R, Kalitzeos A, Michaelides M. Structural and functional characterization of an individual with the M285R KCNV2 hypomorphic allele. Ophthalmic Genet 2024:1-10. [PMID: 38454848 DOI: 10.1080/13816810.2024.2324046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/22/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Disease-causing variants in the KCNV2 gene are associated with "cone dystrophy with supernormal rod responses," a rare autosomal recessive retinal dystrophy. There is no previous report of hypomorphic variants in the disease. MATERIAL AND METHODS Medical history, genetic testing, ocular examination, high-resolution retinal imaging including adaptive optics scanning light ophthalmoscopy (AOSLO), and functional assessments. RESULTS A 16-year-old male with mild cone-rod dystrophy presented with reduced central vision and photophobia. Genetic testing showed two variants in KCNV2, c.614_617dupAGCG (p.207AlafsTer166) and c.854T>G (p.Met285Arg), the latter which was previously considered benign. Electrophysiological assessment revealed the pathognomic electroretinogram waveforms associated with KCNV2-retinopathy. Optical coherence tomography showed discrete focal ellipsoid zone disruption, while fundus autofluorescence was normal. Non-waveguiding cones corresponding to areas of loss of photoreceptor integrity were visible on adaptive optics scanning light ophthalmoscopy. Retinal sensitivity and fixation were relatively preserved, with a demonstrable deterioration after 14 months of follow-up. CONCLUSIONS We provide functional and structural evidence that the variant M285R is disease-causing if associated with a loss-of-function variant. To the best of our knowledge, this is the first hypomorphic allele reported in KCNV2.
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Affiliation(s)
- Thales A C de Guimaraes
- UCL Institute of Ophthalmology, University College London, London, UK
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Francesco Lai
- Unit of Oncology and Molecular Pathology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | | | - Giovanni Sato
- Unit of Low Vision Rehabilitation, Sant'Antonio Hospital, University of Padova, Padova, Italy
| | - Roberta Rizzo
- Unit of Low Vision Rehabilitation, Sant'Antonio Hospital, University of Padova, Padova, Italy
| | - Angelos Kalitzeos
- UCL Institute of Ophthalmology, University College London, London, UK
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Michel Michaelides
- UCL Institute of Ophthalmology, University College London, London, UK
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
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Tsuboi K, Mazloumi M, Guo Y, Wang J, Flaxel CJ, Bailey ST, Wilson DJ, Huang D, Jia Y, Hwang TS. Early Sign of Retinal Neovascularization Evolution in Diabetic Retinopathy: A Longitudinal OCT Angiography Study. OPHTHALMOLOGY SCIENCE 2024; 4:100382. [PMID: 37868804 PMCID: PMC10587637 DOI: 10.1016/j.xops.2023.100382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/12/2023] [Accepted: 08/07/2023] [Indexed: 10/24/2023]
Abstract
Purpose To assess whether the combination of en face OCT and OCT angiography (OCTA) can capture observable, but subtle, structural changes that precede clinically evident retinal neovascularization (RNV) in eyes with diabetic retinopathy (DR). Design Retrospective, longitudinal study. Participants Patients with DR that had at least 2 visits. Methods We obtained wide-field OCTA scans of 1 eye from each participant and generated en face OCT, en face OCTA, and cross-sectional OCTA. We identified eyes with RNV sprouts, defined as epiretinal hyperreflective materials on en face OCT with flow signals breaching the internal limiting membrane on the cross-sectional OCTA without recognizable RNV on en face OCTA and RNV fronds, defined as recognizable abnormal vascular structures on the en face OCTA. We examined the corresponding location from follow-up or previous visits for the presence or progression of the RNV. Main Outcome Measures The characteristics and longitudinal observation of early signs of RNV. Results From 71 eyes, we identified RNV in 20 eyes with the combination of OCT and OCTA, of which 13 (65%) were photographically graded as proliferative DR, 6 (30%) severe nonproliferative DR, and 1 (5%) moderate nonproliferative diabetic retinopathy. From these eyes, we identified 38 RNV sprouts and 26 RNV fronds at the baseline. Thirty-four RNVs (53%) originated from veins, 24 (38%) were from intraretinal microabnormalities, and 6 (9%) were from a nondilated capillary bed. At the final visit, 53 RNV sprouts and 30 RNV fronds were detected. Ten eyes (50%) showed progression, defined as having a new RNV lesion or the development of an RNV frond from an RNV sprout. Four (11%) RNV sprouts developed into RNV fronds with a mean interval of 7.0 months. Nineteen new RNV sprouts developed during the follow-up, whereas no new RNV frond was observed outside an identified RNV sprout. The eyes with progression were of younger age (P = 0.014) and tended to be treatment naive (P = 0.07) compared with eyes without progression. Conclusions Longitudinal observation demonstrated that a combination of en face OCT and cross-sectional OCTA can identify an earlier form of RNV before it can be recognized on en face OCTA. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Kotaro Tsuboi
- Casey Eye Institute, Oregon Health and Science University, Portland, Oregon
- Department of Ophthalmology, Aichi Medical University, 1-1, Yazako-Karimata, Nagakute, Aichi, 480-1195, Japan
| | - Mehdi Mazloumi
- Casey Eye Institute, Oregon Health and Science University, Portland, Oregon
| | - Yukun Guo
- Casey Eye Institute, Oregon Health and Science University, Portland, Oregon
| | - Jie Wang
- Casey Eye Institute, Oregon Health and Science University, Portland, Oregon
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon
| | | | - Steven T. Bailey
- Casey Eye Institute, Oregon Health and Science University, Portland, Oregon
| | - David J. Wilson
- Casey Eye Institute, Oregon Health and Science University, Portland, Oregon
| | - David Huang
- Casey Eye Institute, Oregon Health and Science University, Portland, Oregon
| | - Yali Jia
- Casey Eye Institute, Oregon Health and Science University, Portland, Oregon
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon
| | - Thomas S. Hwang
- Casey Eye Institute, Oregon Health and Science University, Portland, Oregon
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Otero-Marquez O, Ahsanuddin S, Spellman L, Pinhas A, Chui TY, Rosen RB. Imaging vitreous cortex hyalocyte response to paracentral acute middle maculopathy (PAMM) using En Face OCT. Eur J Ophthalmol 2023; 33:NP118-NP121. [PMID: 36377274 PMCID: PMC10183049 DOI: 10.1177/11206721221138303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Vitreous cortex hyalocytes (VCH) are resident macrophage cells that provide immunosurveillance, respond to tissue injury and inflammation, and help maintain the transparency of the media. In this case report we demonstrate the use of en face optical coherence tomography (OCT) to image VCH in vivo in a patient presenting with PAMM secondary to antiphospholipid syndrome. CASE DESCRIPTION A 38-year-old female with no known medical history presented with complaints of visual disturbances in the right eye. OCT revealed hyperreflective bands in the IPL and INL nasal to the fovea. A diagnosis of PAMM was made. Work-up revealed elevated titers of antiphospholipid antibodies. En face OCT revealed a decline in the inflammatory activation over a seven-month period as evidenced by changes in VCH distribution and morphology. CONCLUSIONS Our findings suggest that monitoring changes in the distribution and morphology of VCH could have a potential clinical utility for assessing disease severity, predicting recovery, and early recognition of treatment response in various inflammatory ocular pathologies such as PAMM.
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Affiliation(s)
- Oscar Otero-Marquez
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York City, NY, USA
| | - Sofia Ahsanuddin
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York City, NY, USA
- Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Lily Spellman
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York City, NY, USA
- New York Medical College, Valhalla, NY, USA
| | - Alexander Pinhas
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York City, NY, USA
| | - Toco Y.P Chui
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York City, NY, USA
- Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Richard B. Rosen
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York City, NY, USA
- Icahn School of Medicine at Mount Sinai, New York City, NY, USA
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Hammer DX, Kovalick K, Liu Z, Chen C, Saeedi OJ, Harrison DM. Cellular-Level Visualization of Retinal Pathology in Multiple Sclerosis With Adaptive Optics. Invest Ophthalmol Vis Sci 2023; 64:21. [PMID: 37971733 PMCID: PMC10664728 DOI: 10.1167/iovs.64.14.21] [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: 06/13/2023] [Accepted: 10/09/2023] [Indexed: 11/19/2023] Open
Abstract
Purpose To apply adaptive optics-optical coherence tomography (AO-OCT) to quantify multiple sclerosis (MS)-induced changes in axonal bundles in the macular nerve fiber layer, ganglion cell somas, and macrophage-like cells at the vitreomacular interface. Methods We used AO-OCT imaging in a pilot study of MS participants (n = 10), including those without and with a history of optic neuritis (ON, n = 4), and healthy volunteers (HV, n = 9) to reveal pathologic changes to inner retinal cells and structures affected by MS. Results We found that nerve fiber layer axonal bundles had 38% lower volume in MS participants (1.5 × 10-3 mm3) compared to HVs (2.4 × 10-3 mm3; P < 0.001). Retinal ganglion cell (RGC) density was 51% lower in MS participants (12.3 cells/mm2 × 1000) compared to HVs (25.0 cells/mm2 × 1000; P < 0.001). Spatial differences across the macula were observed in RGC density. RGC diameter was 15% higher in MS participants (11.7 µm) compared to HVs (10.1 µm; P < 0.001). A nonsignificant trend of higher density of macrophage-like cells in MS eyes was also observed. For all AO-OCT measures, outcomes were worse for MS participants with a history of ON compared to MS participants without a history of ON. AO-OCT measures were associated with key visual and physical disabilities in the MS cohort. Conclusions Our findings demonstrate the utility of AO-OCT for highly sensitive and specific detection of neurodegenerative changes in MS. Moreover, the results shed light on the mechanisms that underpin specific neuronal pathology that occurs when MS attacks the retina. The new findings support the further development of AO-based biomarkers for MS.
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Affiliation(s)
- Daniel X. Hammer
- Division of Biomedical Physics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland, United States
| | - Katherine Kovalick
- Division of Biomedical Physics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland, United States
- Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Zhuolin Liu
- Division of Biomedical Physics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland, United States
| | - Chixiang Chen
- Division of Biostatistics and Bioinformatics, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, United States
- Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Osamah J. Saeedi
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Daniel M. Harrison
- Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, United States
- Department of Neurology, Baltimore VA Medical Center, Baltimore, Maryland, United States
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Carreño E, Hernanz I, Collado B, Pichi F. Description of Macrophage-Like Cells in Active Ocular Toxoplasmosis. Ocul Immunol Inflamm 2023:1-4. [PMID: 37787936 DOI: 10.1080/09273948.2023.2263073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 09/19/2023] [Indexed: 10/04/2023]
Abstract
Macrophage-like cells (MLC) have a fundamental role in the maintenance of immunosurveillance, response to inflammation and tissue injury in the retina. MLC can be visualized in vivo with conventional en face optical coherence tomography (OCT). The aim of this study is to describe this population of cells in active toxoplasmosis. We present two cases of active toxoplasma retinochoroiditis imaged at 2 time points, where the MLC were threshold after image processing and averaging for removing background and noise. In both patients the MLC collocated with the area of ischemia at the level of the choriocapillaris and retinal vessels.
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Affiliation(s)
- Ester Carreño
- Department of Ophthalmology, Fundacion Jimenez Diaz University Hospital, Madrid, Spain
- Fundacion Jimenez Diaz Biomedical Research Institute, Madrid, Spain
| | - Inés Hernanz
- Department of Ophthalmology, Fundacion Jimenez Diaz University Hospital, Madrid, Spain
- Fundacion Jimenez Diaz Biomedical Research Institute, Madrid, Spain
| | - Beatriz Collado
- Department of Ophthalmology, Fundacion Jimenez Diaz University Hospital, Madrid, Spain
| | - Francesco Pichi
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
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Abstract
The human retina is amenable to direct, noninvasive visualization using a wide array of imaging modalities. In the ∼140 years since the publication of the first image of the living human retina, there has been a continued evolution of retinal imaging technology. Advances in image acquisition and processing speed now allow real-time visualization of retinal structure, which has revolutionized the diagnosis and management of eye disease. Enormous advances have come in image resolution, with adaptive optics (AO)-based systems capable of imaging the retina with single-cell resolution. In addition, newer functional imaging techniques provide the ability to assess function with exquisite spatial and temporal resolution. These imaging advances have had an especially profound impact on the field of inherited retinal disease research. Here we will review some of the advances and applications of AO retinal imaging in patients with inherited retinal disease.
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Affiliation(s)
- Jacque L Duncan
- Department of Ophthalmology, University of California, San Francisco, California 94143-4081, USA
| | - Joseph Carroll
- Department of Ophthalmology & Visual Sciences, Medical College of Wisconsin Eye Institute, Milwaukee, Wisconsin 53226, USA
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Fallon J, Ahsanuddin S, Otero-Marquez O, Rios HA, Park MM, Chui TY, Rosen RB. Posterior vitreous cortex hyalocytes visualization in asymmetric pigmented paravenous chorioretinal atrophy (PPCRA) using en face OCT. Am J Ophthalmol Case Rep 2023; 30:101846. [PMID: 37114189 PMCID: PMC10126849 DOI: 10.1016/j.ajoc.2023.101846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/26/2023] [Accepted: 04/09/2023] [Indexed: 04/29/2023] Open
Abstract
Purpose Pigmented paravenous chorioretinal atrophy (PPCRA) is a rare retinal disease with inflammatory or infectious associations affecting the retinal pigment epithelium (RPE) and choriocapillaris. While the clinical manifestations and imaging findings are well-documented in the literature, no reports exist describing potential biomarkers of intraocular inflammation or ischemia in this condition, such as the presence of posterior vitreous cortex hyalocytes. Observations We report a case of a 26-year-old female who presented with progressive peripheral vision loss in both eyes over one year. Dilated fundus examination revealed bilateral, asymmetric bone-spicule pigmentary changes along the retinal veins, which appeared more advanced in the left eye. Optical coherence tomography (OCT) revealed the presence of numerous hyalocytes in both eyes 3 μm anterior to the inner limiting membrane (ILM). The morphology of the hyalocytes differed between the two eyes, suggesting different levels of activation related to the stage of the disease. Specifically, the left eye, with more advanced disease, exhibited hyalocytes with multiple elongated processes consistent with a quiescent state, whereas the right eye, with the less advanced disease state, exhibited amoeboid-appearing hyalocytes suggestive of more active inflammation. Conclusions This case illustrates how hyalocyte morphology may reflect the underlying activity of an indolent retinal degeneration and provide a useful biomarker of disease progression.
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Affiliation(s)
- Julia Fallon
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, 310 East 14th Street, New York, NY, 10003, USA
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1183, New York, NY, 10029, USA
| | - Sofia Ahsanuddin
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, 310 East 14th Street, New York, NY, 10003, USA
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1183, New York, NY, 10029, USA
| | - Oscar Otero-Marquez
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, 310 East 14th Street, New York, NY, 10003, USA
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1183, New York, NY, 10029, USA
| | - Hernan Andres Rios
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, 310 East 14th Street, New York, NY, 10003, USA
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1183, New York, NY, 10029, USA
| | - Michael M. Park
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, 310 East 14th Street, New York, NY, 10003, USA
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1183, New York, NY, 10029, USA
| | - Toco Y.P. Chui
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, 310 East 14th Street, New York, NY, 10003, USA
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1183, New York, NY, 10029, USA
| | - Richard B. Rosen
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, 310 East 14th Street, New York, NY, 10003, USA
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1183, New York, NY, 10029, USA
- Corresponding author. 310 E. 14th St, New York, NY, 10003, USA.
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Ahsanuddin S, Rios HA, Glassberg JR, Chui TY, Sebag J, Rosen RB. 3-D OCT imaging of hyalocytes in partial posterior vitreous detachment and vaso-occlusive retinal disease. Am J Ophthalmol Case Rep 2023; 30:101836. [PMID: 37124154 PMCID: PMC10139967 DOI: 10.1016/j.ajoc.2023.101836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 03/10/2023] [Accepted: 03/26/2023] [Indexed: 04/03/2023] Open
Abstract
Purpose To describe the spatial distribution and morphologic characteristics of macrophage-like cells called hyalocytes in the posterior vitreous cortex of a patient with unilateral partial posterior vitreous detachment (PVD) using coronal plane en face optical coherence tomography (OCT). Observations A 54-year-old male with sickle cell disease (HbSC genotype) presented with a partial PVD in one eye. Rendered volumes of a slab extending from 600 μm to 3 μm anterior to the inner limiting membrane (ILM) revealed hyperreflective foci in the detached posterior vitreous cortex suspended anterior to the macula, likely representing hyalocytes. In the fellow eye without PVD, hyperreflective foci were located 3 μm anterior to the ILM. The morphology of the cells in the eye with PVD varied between a ramified state with multiple elongated processes and a more activated state characterized by a plump cell body with fewer retracted processes. In the same anatomical location, the hyperreflective foci were 10-fold more numerous in the patient with vaso-occlusive disease than in an unaffected, age-matched control. Conclusions and Importance Direct, non-invasive, and label-free techniques of imaging cells at the vitreoretinal interface and within the vitreous body is an emerging field. The findings from this case report suggest that coronal plane en face OCT can be used to provide a detailed and quantitative characterization of cells at the human vitreo-retinal interface in vivo. Importantly, this case report demonstrates that 3D-OCT renderings can enhance visualization of these cells in relation to the ILM, which may provide clues concerning the identity and contribution of these cells to the pathogenesis of vitreo-retinal diseases.
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Vitreous Substitutes from Bench to the Operating Room in a Translational Approach: Review and Future Endeavors in Vitreoretinal Surgery. Int J Mol Sci 2023; 24:ijms24043342. [PMID: 36834754 PMCID: PMC9961686 DOI: 10.3390/ijms24043342] [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: 12/20/2022] [Revised: 01/24/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023] Open
Abstract
Vitreous substitutes are indispensable tools in vitreoretinal surgery. The two crucial functions of these substitutes are their ability to displace intravitreal fluid from the retinal surface and to allow the retina to adhere to the retinal pigment epithelium. Today, vitreoretinal surgeons can choose among a plethora of vitreous tamponades, and the tamponade of choice might be difficult to determine in the ever-expanding range of possibilities for a favorable outcome. The currently available vitreous substitutes have disadvantages that need to be addressed to improve the surgical outcome achievable today. Herein, the fundamental physical and chemical proprieties of all vitreous substitutes are reported, and their use and clinical applications are described alongside some surgical techniques of intra-operative manipulation. The major upcoming developments in vitreous substitutes are extensively discussed, keeping a translational perspective throughout. Conclusions on future perspectives are derived through an in-depth analysis of what is lacking today in terms of desired outcomes and biomaterials technology.
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12
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Wang W, Sun G, Xu A, Chen C. Proliferative diabetic retinopathy and diabetic macular edema are two factors that increase macrophage-like cell density characterized by en face optical coherence tomography. BMC Ophthalmol 2023; 23:46. [PMID: 36726090 PMCID: PMC9890872 DOI: 10.1186/s12886-023-02794-8] [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: 11/08/2022] [Accepted: 01/24/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Macrophage-like cells (MLCs) located at the ILM were observed in live human retinas using adaptive optics optical coherence tomography (OCT) as well as clinically-used OCT. The study aimed to quantitatively analyzing MLCs at the vitreoretinal interface (VRI) in diabetic retinopathy (DR) using en face OCT and swept-source optical coherence tomography angiography (SS-OCTA). METHODS 190 DR eyes were included in the study, with 70 proliferative diabetic retinopathy (PDR) eyes and 120 non- proliferative diabetic retinopathy (NPDR) eyes. Sixty-three eyes from normal subjects were included as controls. MLCs were visualized in a 5 μm en face OCT slab above the VRI centered on the fovea. Mann-Whitney U test and Kruskal-Wallis H test were used to compare the OCTA parameters and the MLC parameters among groups. We evaluated the MLC density among groups on binarized images after image processing. We also investigated the relationship between MLC density and other OCT parameters including retina thickness and vessel density (VD). RESULTS The MLC density significantly increased in PDR eyes (PDR vs. NPDR, 8.97 (8.40) cells/mm2 vs.6.14 (8.78) cells/mm2, P = 0.013; PDR vs. normal, 8.97 (8.40) cells/mm2vs. 6.48 (6.71) cells/mm2, P = 0.027) and diabetic macular edema (DME) eyes (DME vs. without DME, 8.94 (8.26) vs.6.09 (9.00), P = 0.005). After adjusting for age and gender, MLC density in NPDR eyes negatively correlated to VD of deep capillary plexus (DCP) (P = 0.01). CONCLUSIONS SS-OCTA is a non-invasive and simple method for the characterization of MLCs at the VRI. PDR and DME are two factors that increase MLC density. MLC density also correlated with VD.
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Affiliation(s)
- Wenyu Wang
- grid.412632.00000 0004 1758 2270Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Gongpeng Sun
- grid.412632.00000 0004 1758 2270Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Amin Xu
- grid.412632.00000 0004 1758 2270Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Changzheng Chen
- grid.412632.00000 0004 1758 2270Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
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Morgan JIW, Chui TYP, Grieve K. Twenty-five years of clinical applications using adaptive optics ophthalmoscopy [Invited]. BIOMEDICAL OPTICS EXPRESS 2023; 14:387-428. [PMID: 36698659 PMCID: PMC9841996 DOI: 10.1364/boe.472274] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/22/2022] [Accepted: 11/27/2022] [Indexed: 05/02/2023]
Abstract
Twenty-five years ago, adaptive optics (AO) was combined with fundus photography, thereby initiating a new era in the field of ophthalmic imaging. Since that time, clinical applications of AO ophthalmoscopy to investigate visual system structure and function in both health and disease abound. To date, AO ophthalmoscopy has enabled visualization of most cell types in the retina, offered insight into retinal and systemic disease pathogenesis, and been integrated into clinical trials. This article reviews clinical applications of AO ophthalmoscopy and addresses remaining challenges for AO ophthalmoscopy to become fully integrated into standard ophthalmic care.
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Affiliation(s)
- Jessica I. W. Morgan
- Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA 19104, USA
- Center for Advanced Retinal and Ocular Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, USA
- Contributed equally
| | - Toco Y. P. Chui
- Department of Ophthalmology, The New York Eye and Ear Infirmary of Mount Sinai, New York, NY 10003, USA
- Contributed equally
| | - Kate Grieve
- Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17 rue Moreau, and CHNO des Quinze-Vingts, INSERM-DGOS CIC 1423, 28 rue de Charenton, F-75012 Paris, France
- Contributed equally
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Rangwani SM, Hawn S, Sklar NC, Mirza RG, Lavine JA. Macrophage-like Cells Are Increased in Retinal Vein Occlusion and Correlate with More Intravitreal Injections and Worse Visual Acuity Outcomes. J Pers Med 2022; 13:45. [PMID: 36675705 PMCID: PMC9860779 DOI: 10.3390/jpm13010045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 12/28/2022] Open
Abstract
Macrophage-like cells (MLCs) are an emerging retinal biomarker. MLCs are increased in retinal vein occlusion (RVO) eyes, but their predictive value is unknown. This study investigated if MLCs can predict meaningful clinical outcomes. This prospective, cross-sectional study involved 46 eyes from 23 patients with unilateral RVO. Patients' unaffected eyes were used as matched controls. MLCs were quantified to determine MLC density and percent image area. We collected demographic, clinical, ocular, and imaging characteristics at the time of MLC imaging. We additionally recorded best corrected visual acuity (BCVA) and number of intravitreal injections at 6 months and 12 months post-imaging. MLC density and percent area increased by 1.86 (p = 0.0266)- and 1.94 (p = 0.0415)-fold in RVO compared to control eyes. We found no significant correlation between MLC parameters and any baseline characteristic. MLC density was positively correlated with the number of intravitreal injections at 6 months (n = 12, r = 0.62, p = 0.03) and 12 months (n = 9, r = 0.80, p = 0.009) post-imaging. MLC percent area was correlated with LogMAR BCVA change over 12 months (n = 17, r = 0.57, p = 0.02). High MLC counts correlated with more future intravitreal injections and worse visual acuity outcomes, suggesting that MLCs are a biomarker for treatment resistant RVO eyes.
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Affiliation(s)
| | | | | | | | - Jeremy A. Lavine
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
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15
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Wang W, Chen C, Yi Z, Wang X, Luo H. Characteristics of macrophage-like cells in acute nonarteritic anterior ischemic optic neuropathy and the normal fellow eyes on en face optical coherence tomography. Front Immunol 2022; 13:1095296. [PMID: 36618342 PMCID: PMC9816328 DOI: 10.3389/fimmu.2022.1095296] [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: 11/11/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose To quantitatively analyze macrophage-like cells (MLCs) at the vitreoretinal interface (VRI) in acute nonarteritic anterior ischemic optic neuropathy (NAION) using en face swept-source optical coherence tomography (OCT). Methods Twenty-five acute NAION eyes and 25 normal fellow eyes from 25 patients were included in the study. MLCs were visualized in a 3 μm 6 mm×6 mm en face OCT slab above the VRI centered on the optic nerve head (ONH). After semiautomatic binarization and quantification, we evaluated the MLC density between the two groups. We also investigated the relationship between MLC density and other OCT parameters, including the increase in peripapillary retinal nerve fiber layer (RNFL) thickness and loss of vessel density (VD) in radical peripapillary capillary (RPC). Results The MLC density in the affected eye of the ONH was highly correlated with that in the fellow eye (r=0.612, p=0.001). The MLC density significantly increased in acute NAION eyes (NAION vs. normal, 11.97 ± 6.66 vs. 9.31 ± 6.10 cell/mm2, p=0.028). In sectorial analysis, the increase in MLCs was mainly in the superior regions (4.13 ± 7.49 vs. 0.94 ± 5.21 cell/mm2, p=0.001). The VD of RPC decreased significantly in the affected eyes (NAION vs. normal, 37.54 ± 5.25 vs. 40.56 ± 4.25, p=0.016), and the loss of RPC was predominantly in the superior sectors and the temporal sectors when compared to the inferior sectors and the nasal sectors, respectively (superior vs. inferior, -3.54 ± 6.71 vs. -0.37 ± 8.07, p=0.004; temporal vs. nasal, -2.69 ± 8.72 vs. -1.22 ± 6.06, p=0.005). The loss of RPC and the increase in MLC density were greater in affected sector corresponding to the visual field (VF) defect. Conclision MLCs located above the VRI increased significantly in acute NAION eyes, especially in subregions corresponding to VF defect, which provides clinical evidence supporting that the inflammatory response participates in the pathological process of NAION. The magnitude of the increase in MLCs corresponds to the RPC loss in the quadrant analysis.
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Affiliation(s)
- Wenyu Wang
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Changzheng Chen
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China,*Correspondence: Changzheng Chen,
| | - Zuohuizi Yi
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xiaoling Wang
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Huijuan Luo
- Department of Ophthalmology, Yidu People’s Hospital, Yichang, China
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Pinhas A, Migacz JV, Zhou DB, Castanos Toral MV, Otero-Marquez O, Israel S, Sun V, Gillette PN, Sredar N, Dubra A, Glassberg J, Rosen RB, Chui TY. Insights into Sickle Cell Disease through the Retinal Microvasculature: Adaptive Optics Scanning Light Ophthalmoscopy Correlates of Clinical OCT Angiography. OPHTHALMOLOGY SCIENCE 2022; 2:100196. [PMID: 36531581 PMCID: PMC9754983 DOI: 10.1016/j.xops.2022.100196] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/14/2022] [Accepted: 07/01/2022] [Indexed: 05/06/2023]
Abstract
PURPOSE Clinical OCT angiography (OCTA) of the retinal microvasculature offers a quantitative correlate to systemic disease burden and treatment efficacy in sickle cell disease (SCD). The purpose of this study was to use the higher resolution of adaptive optics scanning light ophthalmoscopy (AOSLO) to elucidate OCTA features of parafoveal microvascular compromise identified in SCD patients. DESIGN Case series of 11 SCD patients and 1 unaffected control. PARTICIPANTS A total of 11 eyes of 11 SCD patients (mean age, 33 years; range, 23-44; 8 female, 3 male) and 1 eye of a 34-year-old unaffected control. METHODS Ten sequential 3 × 3 mm parafoveal OCTA full vascular slab scans were obtained per eye using a commercial spectral domain OCT system (Avanti RTVue-XR; Optovue). These were used to identify areas of compromised perfusion near the foveal avascular zone (FAZ), designated as regions of interest (ROIs). Immediately thereafter, AOSLO imaging was performed on these ROIs to examine the cellular details of abnormal perfusion. Each participant was imaged at a single cross-sectional time point. Additionally, 2 of the SCD patients were imaged prospectively 2 months after initial imaging to study compromised capillary segments across time and with treatment. MAIN OUTCOME MEASURES Detection and characterization of parafoveal perfusion abnormalities identified using OCTA and resolved using AOSLO imaging. RESULTS We found evidence of abnormal blood flow on OCTA and AOSLO imaging among all 11 SCD patients with diverse systemic and ocular histories. Adaptive optics scanning light ophthalmoscopy imaging revealed a spectrum of phenomena, including capillaries with intermittent blood flow, blood cell stasis, and sites of thrombus formation. Adaptive optics scanning light ophthalmoscopy imaging was able to resolve single sickled red blood cells, rouleaux formations, and blood cell-vessel wall interactions. OCT angiography and AOSLO imaging were sensitive enough to document improved retinal perfusion in an SCD patient 2 months after initiation of oral hydroxyurea therapy. CONCLUSIONS Adaptive optics scanning light ophthalmoscopy imaging was able to reveal the cellular details of perfusion abnormalities detected using clinical OCTA. The synergy between these clinical and laboratory imaging modalities presents a promising avenue in the management of SCD through the development of noninvasive ocular biomarkers to prognosticate progression and measure the response to systemic treatment.
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Key Words
- ADD, airy disk diameter
- AOSLO, adaptive optics scanning light ophthalmoscopy
- Adaptive optics
- BCVA, best-corrected visual acuity
- D, diopters
- FA, fluorescein angiography
- FAZ, foveal avascular zone
- HbSC, hemoglobin SC
- HbSS, hemoglobin SS
- IOP, intraocular pressure
- OCT angiography
- OCTA, OCT angiography
- Oculomics
- RBC, red blood cell
- ROI, region of interest
- Retinal microvasculature
- SCD, sickle cell disease
- SCR, sickle cell retinopathy
- Sickle cell disease
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Affiliation(s)
- Alexander Pinhas
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - Justin V. Migacz
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - Davis B. Zhou
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Maria V. Castanos Toral
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - Oscar Otero-Marquez
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - Sharon Israel
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York
- Department of Human Biology, City University of New York Hunter College, New York, New York
| | - Vincent Sun
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - Peter N. Gillette
- Department of Hematology, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Nripun Sredar
- Department of Ophthalmology, Stanford University, Palo Alto, California
| | - Alfredo Dubra
- Department of Ophthalmology, Stanford University, Palo Alto, California
| | | | - Richard B. Rosen
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Toco Y.P. Chui
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York
- Icahn School of Medicine at Mount Sinai, New York, New York
- Correspondence: Toco Y.P. Chui, PhD, New York Eye and Ear Infirmary of Mount Sinai, 310 E 14th Street, New York, NY 10003.
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Zhang NT, Nesper PL, Ong JX, Wang JM, Fawzi AA, Lavine JA. Macrophage-like Cells Are Increased in Patients with Vision-Threatening Diabetic Retinopathy and Correlate with Macular Edema. Diagnostics (Basel) 2022; 12:2793. [PMID: 36428853 PMCID: PMC9689296 DOI: 10.3390/diagnostics12112793] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/10/2022] [Accepted: 11/12/2022] [Indexed: 11/16/2022] Open
Abstract
Macrophage-like cells (MLCs) are potential inflammatory biomarkers. We previously showed that MLCs are increased in proliferative diabetic retinopathy (PDR) eyes. Vision-threatening diabetic retinopathy (VTDR) includes PDR, severe non-PDR (NPDR), and diabetic macular edema (DME). No prior data exist on MLCs in eyes with severe NPDR or DME. This prospective, cross-sectional optical coherence tomography-angiography (OCT-A) imaging study included 40 eyes of 37 participants who had NPDR classified as non-VTDR (n = 18) or VTDR (n = 22). Repeated OCT-A images were registered, averaged, and used to quantify the main outcome measures: MLC density and percent area. MLC density and percent area were correlated with clinical characteristics, NPDR stage, presence of DME, and OCT central subfield thickness (CST). In VTDR eyes, MLC density (2.6-fold, p < 0.001) and MLC percent area (2.5-fold, p < 0.01) were increased compared with non-VTDR eyes. Multiple linear regression analysis between MLC metrics and clinical characteristics found that MLC density was positively correlated with worse NPDR severity (p = 0.023) and higher CST values (p = 0.010), while MLC percent area was only positively associated with increased CST values (p = 0.006). MLCs are increased in patients with VTDR. Macular edema is the most strongly associated factor with increased MLC numbers in NPDR eyes.
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Affiliation(s)
| | | | | | | | | | - Jeremy A. Lavine
- The Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, 240 E. Huron Street, Bldg. McGaw M343, Chicago, IL 60611, USA
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18
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Liu Z, Zhang F, Zucca K, Agrawal A, Hammer DX. Ultrahigh-speed multimodal adaptive optics system for microscopic structural and functional imaging of the human retina. BIOMEDICAL OPTICS EXPRESS 2022; 13:5860-5878. [PMID: 36733751 PMCID: PMC9872887 DOI: 10.1364/boe.462594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 09/16/2022] [Accepted: 09/20/2022] [Indexed: 05/02/2023]
Abstract
We describe the design and performance of a multimodal and multifunctional adaptive optics (AO) system that combines scanning laser ophthalmoscopy (SLO) and optical coherence tomography (OCT) for simultaneous retinal imaging at 13.4 Hz. The high-speed AO-OCT channel uses a 3.4 MHz Fourier-domain mode-locked (FDML) swept source. The system achieves exquisite resolution and sensitivity for pan-macular and transretinal visualization of retinal cells and structures while providing a functional assessment of the cone photoreceptors. The ultra-high speed also enables wide-field scans for clinical usability and angiography for vascular visualization. The FDA FDML-AO system is a powerful platform for studying various retinal and neurological diseases for vision science research, retina physiology investigation, and biomarker development.
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Affiliation(s)
- Zhuolin Liu
- Center for Devices and Radiological Health
(CDRH), U. S. Food and Drug Administration (FDA), Silver Spring, Maryland 20993, USA
| | - Furu Zhang
- Center for Devices and Radiological Health
(CDRH), U. S. Food and Drug Administration (FDA), Silver Spring, Maryland 20993, USA
- Co-first author
| | - Kelvy Zucca
- Center for Devices and Radiological Health
(CDRH), U. S. Food and Drug Administration (FDA), Silver Spring, Maryland 20993, USA
| | - Anant Agrawal
- Center for Devices and Radiological Health
(CDRH), U. S. Food and Drug Administration (FDA), Silver Spring, Maryland 20993, USA
| | - Daniel X. Hammer
- Center for Devices and Radiological Health
(CDRH), U. S. Food and Drug Administration (FDA), Silver Spring, Maryland 20993, USA
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Jones CH, Gui W, Schumann RG, Boneva SK, Lange CAK, van Overdam KA, Chui TYP, Rosen RB, Engelbert M, Sebag J. Hyalocytes in proliferative vitreo-retinal diseases. EXPERT REVIEW OF OPHTHALMOLOGY 2022; 17:263-280. [DOI: 10.1080/17469899.2022.2100764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
| | - Wei Gui
- VMR Institute for Vitreous Macula Retina, Huntington Beach, California, USA
| | - Ricarda G. Schumann
- Department of Ophthalmology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Stefaniya K. Boneva
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Clemens A. K. Lange
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Ophtha-Lab, Department of Ophthalmology at St. Franziskus Hospital, Muenster, Germany
| | - Koen A. van Overdam
- Department of Vitreo-Retinal surgery, The Rotterdam Eye Hospital, Rotterdam, The Netherlands
| | - Toco Y. P. Chui
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Richard B. Rosen
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael Engelbert
- Vitreous Retina Macula Consultants of New York
- NYU School of Medicine, New York, NY, USA
| | - J. Sebag
- VMR Institute for Vitreous Macula Retina, Huntington Beach, California, USA
- Doheny Eye Institute, UCLA, Pasadena, California, USA
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20
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Thomas CN, Alfahad N, Capewell N, Cowley J, Hickman E, Fernandez A, Harrison N, Qureshi OS, Bennett N, Barnes NM, Dick AD, Chu CJ, Liu X, Denniston AK, Vendrell M, Hill LJ. Triazole-derivatized near-infrared cyanine dyes enable local functional fluorescent imaging of ocular inflammation. Biosens Bioelectron 2022; 216:114623. [PMID: 36029662 DOI: 10.1016/j.bios.2022.114623] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/28/2022] [Accepted: 08/03/2022] [Indexed: 11/26/2022]
Abstract
Near-infrared (NIR) chemical fluorophores are promising tools for in-vivo imaging in real time but often succumb to rapid photodegradation. Indocyanine green (ICG) is the only NIR dye with regulatory approval for ocular imaging in humans; however, ICG, when employed for applications such as labelling immune cells, has limited sensitivity and does not allow precise detection of specific inflammatory events, for example leukocyte recruitment during uveitic flare-ups. We investigated the potential use of photostable novel triazole NIR cyanine (TNC) dyes for detecting and characterising activated T-cell activity within the eye. Three TNC dyes were evaluated for ocular cytotoxicity in-vitro using a MTT assay and optimised concentrations for intraocular detection within ex-vivo porcine eyes after topical application or intracameral injections of the dyes. TNC labelled T-cell tracking experiments and mechanistic studies were also performed in-vitro. TNC-1 and TNC-2 dyes exhibited greater fluorescence intensity than ICG at 10 μM, whereas TNC-3 was only detectable at 100 μM within the porcine eye. TNC dyes did not demonstrate any ocular cell toxicity at working concentrations of 10 μM. CD4+T-cells labelled with TNC-1 or TNC-2 were detected within the porcine eye, with TNC-1 being brighter than TNC-2. Detection of TNC-1 and TNC-2 into CD4+T-cells was prevented by prior incubation with dynole 34-2 (50 μM), suggesting active uptake of these dyes via dynamin-dependent processes. The present study provides evidence that TNC dyes are suitable to detect activated CD4+T-cells within the eye with potential as a diagnostic marker for ocular inflammatory diseases.
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Affiliation(s)
- Chloe N Thomas
- School of Biomedical Sciences, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
| | - Nada Alfahad
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Nicholas Capewell
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jamie Cowley
- Celentyx Ltd, Birmingham Research Park, Vincent Drive, Edgbaston, Birmingham, UK
| | - Eleanor Hickman
- School of Biomedical Sciences, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Antonio Fernandez
- Department of Organic Chemistry, Faculty of Chemistry, University of Murcia, Murcia, Spain; Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Neale Harrison
- Celentyx Ltd, Birmingham Research Park, Vincent Drive, Edgbaston, Birmingham, UK
| | - Omar S Qureshi
- Celentyx Ltd, Birmingham Research Park, Vincent Drive, Edgbaston, Birmingham, UK
| | - Naomi Bennett
- School of Biomedical Sciences, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; Healthcare Technologies Institute, School of Chemical Engineering, University of Birmingham, Birmingham, UK
| | - Nicholas M Barnes
- Neuropharmacology Research Group, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Andrew D Dick
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, UK; Academic Unit of Ophthalmology, Bristol Medical School and School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Colin J Chu
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, UK; Academic Unit of Ophthalmology, Bristol Medical School and School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Xiaoxuan Liu
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK; University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK; Health Data Research UK, London, UK
| | - Alastair K Denniston
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK; University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, UK; Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK; Health Data Research UK, London, UK; Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Marc Vendrell
- Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Lisa J Hill
- School of Biomedical Sciences, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
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21
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Rajesh A, Droho S, Lavine JA. Macrophages in close proximity to the vitreoretinal interface are potential biomarkers of inflammation during retinal vascular disease. J Neuroinflammation 2022; 19:203. [PMID: 35941655 PMCID: PMC9361599 DOI: 10.1186/s12974-022-02562-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/29/2022] [Indexed: 12/21/2022] Open
Abstract
Background Diabetic retinopathy and retinal vein occlusion are vision threatening retinal vascular diseases. Current first-line therapy targets the vascular component, but many patients are treatment-resistant due to unchecked inflammation. Non-invasive inflammatory imaging biomarkers are a significant unmet clinical need for patients. Imaging of macrophage-like cells on the surface of the retina using clinical optical coherence tomography (OCT) is an emerging field. These cells are increased in patients with retinal vascular disease, and could be a potential inflammatory biomarker. However, since OCT is limited by an axial resolution of 5–10 microns, the exact location and identity of these retinal cells is currently unknown. Methods We performed OCT followed by confocal immunofluorescence in wild-type mice to identify macrophages within 5–10 microns of the vitreoretinal interface. Next, we used Cx3cr1CreER/+; Rosa26zsGreen/+ mice to fate map retinal surface macrophages. Using confocal immunofluorescence of retinal sections and flatmounts, we quantified IBA1+Tmem119+CD169neg microglia, IBA1+Tmem119negCD169neg perivascular macrophages, and IBA1+Tmem119negCD169+ vitreal hyalocytes. Finally, we modeled neuroinflammation with CCL2 treatment and characterized retinal surface macrophages using flow cytometry, OCT, and confocal immunofluorescence. Results We were able to detect IBA1+ macrophages within 5–10 microns of the vitreoretinal interface in wild-type mice using OCT followed by confirmatory confocal immunofluorescence. Retinal surface macrophages were 83.5% GFP+ at Week 1 and 82.4% GFP+ at Week 4 using fate mapping mice. At steady state, these macrophages included 82% IBA1+Tmem119+CD169neg microglia, 9% IBA1+Tmem119negCD169+ vitreal hyalocytes, and 9% IBA1+Tmem119negCD169neg perivascular macrophages. After CCL2-driven neuroinflammation, many Ly6C+ cells were detectable on the retinal surface using OCT followed by confocal immunofluorescence. Conclusions Macrophages within close proximity to the vitreoretinal interface are self-renewing cells, and predominantly microglia with minor populations of perivascular macrophages and vitreal hyalocytes at steady state. In the context of neuroinflammation, monocytes and monocyte-derived macrophages are a significant component of retinal surface macrophages. Human OCT-based imaging of retinal surface macrophages is a potential biomarker for inflammation during retinal vascular disease. Supplementary Information The online version contains supplementary material available at 10.1186/s12974-022-02562-3.
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Affiliation(s)
- Amrita Rajesh
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, 240 E Huron St, McGaw M343, Chicago, IL, 60611, USA
| | - Steven Droho
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, 240 E Huron St, McGaw M343, Chicago, IL, 60611, USA
| | - Jeremy A Lavine
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, 240 E Huron St, McGaw M343, Chicago, IL, 60611, USA.
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22
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Wang JM, Ong JX, Nesper PL, Fawzi AA, Lavine JA. Macrophage-like cells are still detectable on the retinal surface after posterior vitreous detachment. Sci Rep 2022; 12:12864. [PMID: 35896600 PMCID: PMC9329361 DOI: 10.1038/s41598-022-17229-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/21/2022] [Indexed: 11/25/2022] Open
Abstract
The identity of vitreoretinal interface macrophage-like cells (MLCs) remains unknown and potential candidates include retinal microglia, perivascular macrophages, monocyte-derived macrophages, and/or vitreal hyalocytes. Since hyalocytes are detectable on the posterior vitreous surface after vitreous extraction in animals, we imaged patients with and without posterior vitreous detachment (PVD) to determine if hyalocytes are the principal MLC component. We performed repeated foveal-centered 3 × 3 mm OCT-A images from 21 eyes (11 no PVD and 10 PVD eyes). Images were registered, segmented, and averaged. The OCT slab from 0 to 3 microns above the internal limiting membrane was used to detect MLCs. We calculated MLC density and distribution in relation to the superficial vascular plexus for 3 vascular regions-on vessels, perivascular, and non-vascular. MLC density was 1.8-fold greater in the PVD group compared to the no PVD group (P = 0.04). MLCs in eyes with PVD were increased 1.9-fold on-vessel (P = 0.07), 1.9-fold in the perivascular region (P = 0.12), and 2.2-fold in non-vascular areas (P = 0.22). MLC density was not severely reduced after PVD, suggesting that the majority of MLCs are not vitreal hyalocytes. PVD status is an important parameter in future MLC studies.
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Affiliation(s)
- Jacob M Wang
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Janice X Ong
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Peter L Nesper
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Amani A Fawzi
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jeremy A Lavine
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, 240 E. Huron Street, Bldg. McGaw M343, Chicago, IL, 60611, USA.
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23
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Boneva SK, Wolf J, Wieghofer P, Sebag J, Lange CAK. Hyalocyte functions and immunology. EXPERT REVIEW OF OPHTHALMOLOGY 2022. [DOI: 10.1080/17469899.2022.2100763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Stefaniya K Boneva
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Julian Wolf
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter Wieghofer
- Cellular Neuroanatomy, Institute of Theoretical Medicine, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - J Sebag
- Doheny Eye Institute, UCLA, Pasadena, CA, USA
- UCLA Geffen School of Medicine, Los Angeles, CA, USA
- VMR Institute for Vitreous Macula Retina, Huntington Beach, California, USA
| | - Clemens AK Lange
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Ophtha-Lab, Department of Ophthalmology at St. Franziskus Hospital, Muenster, Germany
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24
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Zeng Y, Zhang X, Mi L, Ji Y, Zhuang X, He G, Chen X, Wen F. Macrophage-like Cells Characterized by En Face Optical Coherence Tomography was Associated with Fluorescein Vascular Leakage in Behçet's Uveitis. Ocul Immunol Inflamm 2022:1-7. [PMID: 35708322 DOI: 10.1080/09273948.2022.2080719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE To investigate the features of macrophage-like cell (MLC) characterized by en face optical coherence tomography (OCT) in Behçet's uveitis (BU). METHODS The extent of fluorescein vascular leakage (FVL) was graded on a scale of 0-3 (0=none, 1=mild, 2=moderate, 3=severe) for the optic nerve head (ONH), macula and peripheral retina. The 3μm en face OCT slabs on inner limiting membrane of ONH or macular region was used to visualize the MLCs. RESULTS The MLC densities of BU group in ONH and macular region were significantly higher than the control group (both p<0.001). The ONH and macular MLC density were significantly higher in eyes with higher FVL grade and they were positively correlated with FVL score (all p<0.001). CONCLUSION MLC density was elevated in Behçet's uveitis and it may serve as a noninvasive indicator for the severity of fluorescein leakage and retinal inflammation in Behcet's uveitis.
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Affiliation(s)
- Yunkao Zeng
- Department of ophthalmology, 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
| | - Xiongze Zhang
- Department of ophthalmology, 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
| | - Lan Mi
- Department of ophthalmology, 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
| | - Yuying Ji
- Department of ophthalmology, 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
| | - Xuenan Zhuang
- Department of ophthalmology, 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
| | - Guiqin He
- Department of ophthalmology, 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
| | - Xuelin Chen
- Department of ophthalmology, 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
| | - Feng Wen
- Department of ophthalmology, 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
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25
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Wieghofer P, Engelbert M, Chui TYP, Rosen RB, Sakamoto T, Sebag J. Hyalocyte origin, structure, and imaging. EXPERT REVIEW OF OPHTHALMOLOGY 2022; 17:233-248. [PMID: 36632192 PMCID: PMC9831111 DOI: 10.1080/17469899.2022.2100762] [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: 01/14/2023]
Abstract
Introduction Hyalocytes have been recognized as resident tissue macrophages of the vitreous body since the mid-19th century. Despite this, knowledge about their origin, turnover, and dynamics is limited. Areas covered Historically, initial studies on the origin of hyalocytes used light and electron microscopy. Modern investigations across species including rodents and humans will be described. Novel imaging is now available to study human hyalocytes in vivo. The shared ontogeny with retinal microglia and their eventual interdependence as well as differences will be discussed. Expert opinion Owing to a common origin as myeloid cells, hyalocytes and retinal microglia have similarities, but hyalocytes appear to be distinct as resident macrophages of the vitreous body.
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Affiliation(s)
- Peter Wieghofer
- Cellular Neuroanatomy, Institute of Theoretical Medicine, Medical Faculty, University of Augsburg, Universitätsstraße 2, 86159 Augsburg, Germany,Corresponding authors: Peter Wieghofer. , J Sebag.
| | - Michael Engelbert
- Vitreous Retina Macula Consultants of New York, New York, NY 10022, USA.,LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, NY 10065, USA.,Department of Ophthalmology, New York University School of Medicine, New York, NY 10016, USA
| | - Toco YP Chui
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York; Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Richard B Rosen
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York; Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Science, Kagoshima, Japan
| | - J Sebag
- Doheny Eye Institute, UCLA, Los Angeles, CA, USA.,Clinical Ophthalmology, Stein Eye Institute, Geffen School of Medicine, UCLA, Los Angeles, CA, USA.,VMR Institute for Vitreous Macula Retina, Huntington Beach, CA, USA.,Corresponding authors: Peter Wieghofer. , J Sebag.
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