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Nelis P, Nieweler A, Brücher V, Eter N, Ten Tusscher M, Alnawaiseh M. Light conditions influence optic nerve OCT angiography parameter in healthy subjects with neutral pupils. Sci Rep 2023; 13:9154. [PMID: 37280254 DOI: 10.1038/s41598-023-36069-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 05/29/2023] [Indexed: 06/08/2023] Open
Abstract
Optical coherence tomography angiography measurements are influenced by a range of environmental factors as blood pressure and physical fitness. The present study aimed to evaluate the effects of light and dark exposure in eyes with neutral and mydriatic pupils on vessel density in the macular and optic nerve head regions, as measured using optical coherence tomography angiography (OCTA). 55 eyes of 55 healthy volunteers (28 patients with neutral pupils; 27.18 ± 4.33 years) were examined using a high-speed and high-resolution spectral-domain OCT XR Avanti system with a split-spectrum amplitude de-correlation angiography algorithm. OCTA imaging was performed after dark adaptation and after exposure to light. The vessel density data of the superficial and deep retinal macular and optic nerve head region OCT-angiogram were analyzed for these two light conditions. Through Bonferroni correction for multiple testing, the p- value was adapted from 0.05 to 0.017. In eyes with neutral pupils, a significant increase was found in the capillary region of the optic nerve head region (p = 0.002), comparing dark- and light-adaptation. In the macular region of eyes with neutral (p = 0.718) and mydriatic pupils (p = 0.043), no significant differences were observed, as were any in the optic nerve head region of the mydriatic eyes (p = 0.797). This observation suggests that light conditions could be a possible factor influencing OCTA measurements. After dark exposure, vessel density data were significantly different between eyes with neutral and mydriatic pupils (nerve head region: p < 0.0001, superficial macula: p < 0.0001, deep macula: p = 0.0025). These data warn for the effect of mydriatic drops on vessel density measurements.
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Affiliation(s)
- Pieter Nelis
- Department of Ophthalmology, University of Muenster Medical Center, Albert-Schweitzer-Campus 1, Building D15, 48149, Muenster, Germany.
- Department of Ophthalmology, Vrije Universiteit Brussel, Brussels, Belgium.
- Department of Ophthalmology, Helios Augenklinik Berlin-Buch, Berlin-Buch, Germany.
| | - A Nieweler
- Department of Ophthalmology, University of Muenster Medical Center, Albert-Schweitzer-Campus 1, Building D15, 48149, Muenster, Germany
| | - V Brücher
- Department of Ophthalmology, University of Muenster Medical Center, Albert-Schweitzer-Campus 1, Building D15, 48149, Muenster, Germany
| | - N Eter
- Department of Ophthalmology, University of Muenster Medical Center, Albert-Schweitzer-Campus 1, Building D15, 48149, Muenster, Germany
| | - M Ten Tusscher
- Department of Ophthalmology, Vrije Universiteit Brussel, Brussels, Belgium
| | - M Alnawaiseh
- Department of Ophthalmology, University of Muenster Medical Center, Albert-Schweitzer-Campus 1, Building D15, 48149, Muenster, Germany
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Lee T, Rivera A, Brune M, Kundu A, Haystead A, Winslow L, Kundu R, Wisely CE, Robbins CB, Henao R, Grewal DS, Fekrat S. Convolutional Neural Network-Based Automated Quality Assessment of OCT and OCT Angiography Image Maps in Individuals With Neurodegenerative Disease. Transl Vis Sci Technol 2023; 12:30. [PMID: 37389540 PMCID: PMC10318591 DOI: 10.1167/tvst.12.6.30] [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: 04/01/2023] [Accepted: 06/04/2023] [Indexed: 07/01/2023] Open
Abstract
Purpose To train and test convolutional neural networks (CNNs) to automate quality assessment of optical coherence tomography (OCT) and OCT angiography (OCTA) images in patients with neurodegenerative disease. Methods Patients with neurodegenerative disease were enrolled in the Duke Eye Multimodal Imaging in Neurodegenerative Disease Study. Image inputs were ganglion cell-inner plexiform layer (GC-IPL) thickness maps and fovea-centered 6-mm × 6-mm OCTA scans of the superficial capillary plexus (SCP). Two trained graders manually labeled all images for quality (good versus poor). Interrater reliability (IRR) of manual quality assessment was calculated for a subset of each image type. Images were split into train, validation, and test sets in a 70%/15%/15% split. An AlexNet-based CNN was trained using these labels and evaluated with area under the receiver operating characteristic (AUC) and summaries of the confusion matrix. Results A total of 1465 GC-IPL thickness maps (1217 good and 248 poor quality) and 2689 OCTA scans of the SCP (1797 good and 892 poor quality) served as model inputs. The IRR of quality assessment agreement by two graders was 97% and 90% for the GC-IPL maps and OCTA scans, respectively. The AlexNet-based CNNs trained to assess quality of the GC-IPL images and OCTA scans achieved AUCs of 0.990 and 0.832, respectively. Conclusions CNNs can be trained to accurately differentiate good- from poor-quality GC-IPL thickness maps and OCTA scans of the macular SCP. Translational Relevance Since good-quality retinal images are critical for the accurate assessment of microvasculature and structure, incorporating an automated image quality sorter may obviate the need for manual image review.
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Affiliation(s)
- Terry Lee
- iMIND Study Group, Duke University School of Medicine, Durham, NC, USA
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Alexandra Rivera
- iMIND Study Group, Duke University School of Medicine, Durham, NC, USA
- Pratt School of Engineering, Duke University, Durham, NC, USA
| | - Matthew Brune
- iMIND Study Group, Duke University School of Medicine, Durham, NC, USA
- Pratt School of Engineering, Duke University, Durham, NC, USA
| | - Anita Kundu
- iMIND Study Group, Duke University School of Medicine, Durham, NC, USA
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Alice Haystead
- iMIND Study Group, Duke University School of Medicine, Durham, NC, USA
- Pratt School of Engineering, Duke University, Durham, NC, USA
| | - Lauren Winslow
- iMIND Study Group, Duke University School of Medicine, Durham, NC, USA
- Pratt School of Engineering, Duke University, Durham, NC, USA
| | - Raj Kundu
- iMIND Study Group, Duke University School of Medicine, Durham, NC, USA
- Pratt School of Engineering, Duke University, Durham, NC, USA
| | - C. Ellis Wisely
- iMIND Study Group, Duke University School of Medicine, Durham, NC, USA
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Cason B. Robbins
- iMIND Study Group, Duke University School of Medicine, Durham, NC, USA
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Ricardo Henao
- Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC, USA
| | - Dilraj S. Grewal
- iMIND Study Group, Duke University School of Medicine, Durham, NC, USA
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Sharon Fekrat
- iMIND Study Group, Duke University School of Medicine, Durham, NC, USA
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
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Müller M, Schottenhamml J, Hosari S, Hohberger B, Mardin CY. APSified OCT-angiography analysis: Macula vessel density in healthy eyes during office hours. PLoS One 2023; 18:e0282827. [PMID: 36893212 PMCID: PMC9997993 DOI: 10.1371/journal.pone.0282827] [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: 01/04/2022] [Accepted: 02/23/2023] [Indexed: 03/10/2023] Open
Abstract
PURPOSE Optical coherence tomography angiography (OCT-A) can visualize retinal capillary microcirculation non-invasively. In order to investigate potential factors influencing OCT-A diagnostics, the aim of the present study was to determine circadian changes in macular vessel density (VD) in healthy adults during office hours, considering axial length (AL) and subfoveal choroidal thickness (CT). METHODS In the prospective study 30 eyes of 30 healthy subjects (mean age 28.7 ± 11.8, range 19-60 years) were recruited who underwent repeated measurements of AL, subfoveal CT and three-layer macula VD (superficial vascular plexus (SVP), intermediate capillary plexus (ICP) and deep capillary plexus (DCP)) on a single day at three predetermined timepoints (9 AM, 3 PM, and 9 PM). For better intra- and interindividual scan comparability, the new Anatomic Positioning System function (APS, part of Glaucoma Module Premium Edition [GMPE], Heidelberg Engineering, Germany) allowing analysis of identical retinal areas, was used for quantitative OCT-A analysis. RESULTS Overall mean macula VD was unchanged during office hours in SVP, ICP and DCP, respectively (p>0.05). In addition, AL and CT showed no statistically significant changes over time (p>0.05). Rather, a large interindividual variance of VD with different peak time was observed. Contrary to the overall data, sectorial VD changed in dependency of office hours in all layers with an increase of VD in SVP between 9 AM and 9 PM (p = 0.003), in ICP between 3 PM and 9 PM (p = 0.000), in DCP between 9 AM and 9 PM (p = 0.048), and 3 PM and 9 PM (p = 0.000), respectively. CONCLUSION Overall mean macula VD, subfoveal CT and AL tended not to show statistically significant changes over time in this cohort, whereas a regional analysis of VD did. Therefore, a circadian influence on capillary microcirculation should be kept in mind. Moreover, the results highlight the importance of a more detailed analysis of VD in different sectors and different vascular layers. In addition, the pattern of diurnal variation could vary inter-individually, thus a patient-specific fluctuation pattern would need to be considered when evaluating these parameters in clinical practice.
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Affiliation(s)
- Meike Müller
- Department of Ophthalmology, Friedrich-Alexander-Universität of Erlangen-Nürnberg, Erlangen, Bavaria, Germany
| | - Julia Schottenhamml
- Department of Ophthalmology, Friedrich-Alexander-Universität of Erlangen-Nürnberg, Erlangen, Bavaria, Germany
- Department of Computer Science, Friedrich-Alexander-Universität of Erlangen-Nürnberg, Erlangen, Bavaria, Germany
| | - Sami Hosari
- Department of Ophthalmology, Friedrich-Alexander-Universität of Erlangen-Nürnberg, Erlangen, Bavaria, Germany
| | - Bettina Hohberger
- Department of Ophthalmology, Friedrich-Alexander-Universität of Erlangen-Nürnberg, Erlangen, Bavaria, Germany
| | - Christian Y. Mardin
- Department of Ophthalmology, Friedrich-Alexander-Universität of Erlangen-Nürnberg, Erlangen, Bavaria, Germany
- * E-mail:
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Post-COVID-19 Syndrome: Retinal Microcirculation as a Potential Marker for Chronic Fatigue. Int J Mol Sci 2022; 23:ijms232213683. [PMID: 36430175 PMCID: PMC9690863 DOI: 10.3390/ijms232213683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/04/2022] [Accepted: 11/05/2022] [Indexed: 11/10/2022] Open
Abstract
Post-COVID-19 syndrome (PCS) is characterized by persisting sequelae after infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). PCS can affect patients with all COVID-19 disease severities. As previous studies have revealed impaired blood flow as a provoking factor triggering PCS, it was the aim of the present study to investigate the potential association between self-reported chronic fatigue and retinal microcirculation in patients with PCS, potentially indicating an objective biomarker. A prospective study was performed, including 201 subjects: 173 patients with PCS and 28 controls. Retinal microcirculation was visualized by OCT angiography (OCT-A) and quantified using the Erlangen-Angio-Tool as macula and peripapillary vessel density (VD). Chronic fatigue (CF) was assessed according to the variables of Bell’s score, age and gender. VDs in the superficial vascular plexus (SVP), intermediate capillary plexus (ICP) and deep capillary plexus (DCP) were analyzed, considering the repetitions (12 times). Seropositivity for autoantibodies targeting G protein-coupled receptors (GPCR-AAbs) was determined by an established cardiomyocyte bioassay. Taking account of the repetitions, a mixed model was performed to detect possible differences in the least square means between the different groups included in the analysis. An age effect in relation to VD was observed between patients and controls (p < 0.0001). Gender analysis showed that women with PCS showed lower VD levels in the SVP compared to male patients (p = 0.0015). The PCS patients showed significantly lower VDs in the ICP as compared to the controls (p = 0.0001 (CI: 0.32; 1)). Moreover, considering PCS patients, the mixed model revealed a significant difference between those with chronic fatigue (CF) and those without CF with respect to VDs in the SVP (p = 0.0033 (CI: −4.5; −0.92)). The model included variables of age, gender and Bell’s score, representing a subjective marker for CF. Consequently, retinal microcirculation might serve as an objective biomarker in subjectively reported chronic fatigue in patients with PCS.
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Effect of Mydriatic Administration On Retinal Hemodynamics in Glaucoma: An Optical Coherence Tomography Angiography Study. J Glaucoma 2022; 31:659-665. [PMID: 35439783 DOI: 10.1097/ijg.0000000000002039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 04/02/2022] [Indexed: 11/26/2022]
Abstract
PRCIS Pupillary dilation with 0.5% tropicamide and 2.5% phenylephrine resulted in a statistically significant decrease in foveal avascular zone (FAZ) metrics in glaucoma eyes. This observation emphasizes the critical role of pupillary status in interpreting glaucomatous vascular alterations detected by OCTA. PURPOSE To evaluate the influence of mydriatic eye drops on optical coherence tomography angiography (OCTA) parameters in patients with primary open-angle glaucoma (POAG). METHODS A total of 20 POAG eyes and 20 control eyes were recruited in the study. The imaging area on the fundus was visualized by AngioPlex (Cirrus 5000 HD-OCT; Carl Zeiss Meditec) using en face view of 3×3▒mm and 6×6▒mm preview scans. Images were generated before and after the instillation of topical 0.5% tropicamide and 2.5% phenylephrine. Optic nerve head (ONH) perfusion, ONH flux index, macular perfusion density, macular vessel density, and foveal avascular zone (FAZ) measurements were consecutively obtained for each session. Differences between the pre-and post-dilation measurements were evaluated in POAG patients and controls. RESULTS POAG eyes showed a statistically significant decrease in the FAZ area from a mean of 0.29▒mm2to 0.25▒mm2(P=0.037) and FAZ perimeter from a mean of 2.27▒mm to 2.09▒mm (P=0.045) in the OCTA 6×6▒mm scan area after tropicamide/phenylephrine instillation. Pre-and post-dilation measurements of ONH perfusion and ONH flux index were significantly lower in the glaucoma group compared to controls (P<0.05, for all). CONCLUSION Topical pupillary dilation with 0.5% tropicamide and 2.5% phenylephrine results in a statistically significant reduction in the FAZ area and FAZ perimeter in POAG eyes. Further OCTA studies are needed for the diagnostic value of vascular changes due to pupil dilation in glaucoma.
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Evaluation of peripapillary - macular microvascularity and choroidal vascularity index after refractive surgery. Photodiagnosis Photodyn Ther 2022; 37:102714. [PMID: 34995787 DOI: 10.1016/j.pdpdt.2022.102714] [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] [Received: 08/31/2021] [Revised: 12/26/2021] [Accepted: 01/03/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND To evaluate the microvascularity and choroidal vascularity index (CVI) using optical coherence tomography angiography (OCTA) and OCT following femtosecond laser-assisted in-situ keratomileusis (FS-LASIK) and small incision lenticule extraction (SMILE) procedures. METHODS Patients with myopia (<-6.0D sphere) or myopic astigmatism (<-4.0D astigmatism) were enroled. The percentage of vessel density and foveal avascular zone (FAZ) size, optic disc flux index and perfusion were noted and the CVI was calculated before and after surgery. RESULTS Twenty-nine eyes of 16 patients in the FS-LASIK group and 30 eyes of 16 patients in the SMILE group were enroled. Macular vessel density, FAZ size, and optic disc flux index were significantly higher on postoperative 1st day compared to preoperative day (p = 0.001, p = 0.007, and p < 0.001, respectively). There was no significant difference in terms of macular and peripapillary CVI between postoperative 1st day and preoperative day (p > 0.05). All microvascular parameters were similar on postoperative 7th day and preoperative day (p > 0.05). CONCLUSIONS It was detected that there is a transient alteration in macular and peripapillary microvascularity after FS-LASIK/SMILE, whereas choroidal circularity is not significantly affected by these refractive surgeries.
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Neumaier F, Kotliar K, Haeren RHL, Temel Y, Lüke JN, Seyam O, Lindauer U, Clusmann H, Hescheler J, Schubert GA, Schneider T, Albanna W. Retinal Vessel Responses to Flicker Stimulation Are Impaired in Ca v 2.3-Deficient Mice-An in-vivo Evaluation Using Retinal Vessel Analysis (RVA). Front Neurol 2021; 12:659890. [PMID: 33927686 PMCID: PMC8076560 DOI: 10.3389/fneur.2021.659890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/17/2021] [Indexed: 12/30/2022] Open
Abstract
Objective: Metabolic demand increases with neuronal activity and adequate energy supply is ensured by neurovascular coupling (NVC). Impairments of NVC have been reported in the context of several diseases and may correlate with disease severity and outcome. Voltage-gated Ca2+-channels (VGCCs) are involved in the regulation of vasomotor tone. In the present study, we compared arterial and venous responses to flicker stimulation in Cav2.3-competent (Cav2.3[+/+]) and -deficient (Cav2.3[-/-]) mice using retinal vessel analysis. Methods: The mice were anesthetized and the pupil of one eye was dilated by application of a mydriaticum. An adapted prototype of retinal vessel analyzer was used to perform dynamic retinal vessel analysis. Arterial and venous responses were quantified in terms of the area under the curve (AUCart/AUCven) during flicker application, mean maximum dilation (mMDart/mMDven) and time to maximum dilation (tMDart/tMDven) during the flicker, dilation at flicker cessation (DFCart/DFCven), mean maximum constriction (mMCart/mMCven), time to maximum constriction (tMCart/tMCven) after the flicker and reactive magnitude (RMart/RMven). Results: A total of 33 retinal scans were conducted in 22 Cav2.3[+/+] and 11 Cav2.3[-/-] mice. Cav2.3[-/-] mice were characterized by attenuated and partially reversed arterial and venous responses, as reflected in significantly lower AUCart (p = 0.031) and AUCven (p = 0.047), a trend toward reduced DFCart (p = 0.100), DFCven (p = 0.100), mMDven (p = 0.075), and RMart (p = 0.090) and a trend toward increased tMDart (p = 0.096). Conclusion: To our knowledge, this is the first study using a novel, non-invasive analysis technique to document impairment of retinal vessel responses in VGCC-deficient mice. We propose that Cav2.3 channels could be involved in NVC and may contribute to the impairment of vasomotor responses under pathophysiological conditions.
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Affiliation(s)
- Felix Neumaier
- Department of Neurosurgery, RWTH Aachen University, Aachen, Germany
- Forschungszentrum Jülich GmbH, Institute of Neuroscience and Medicine, Nuclear Chemistry (INM-5), Jülich, Germany
- Institute of Radiochemistry and Experimental Molecular Imaging, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Konstantin Kotliar
- Department of Medical Engineering and Technomathematics, FH Aachen University of Applied Sciences, Aachen, Germany
| | | | - Yasin Temel
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Jan Niklas Lüke
- Institute for Neurophysiology, University of Cologne, Cologne, Germany
| | - Osama Seyam
- Department of Medical Engineering and Technomathematics, FH Aachen University of Applied Sciences, Aachen, Germany
| | - Ute Lindauer
- Department of Neurosurgery, RWTH Aachen University, Aachen, Germany
- Tranlational Neurosurgery and Neurobiology, RWTH Aachen University, Aachen, Germany
| | - Hans Clusmann
- Department of Neurosurgery, RWTH Aachen University, Aachen, Germany
| | - Jürgen Hescheler
- Institute for Neurophysiology, University of Cologne, Cologne, Germany
| | | | - Toni Schneider
- Institute for Neurophysiology, University of Cologne, Cologne, Germany
| | - Walid Albanna
- Department of Neurosurgery, RWTH Aachen University, Aachen, Germany
- Institute for Neurophysiology, University of Cologne, Cologne, Germany
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Elbeyli A, Kurtul B. The influence of topical cyclopentolate instillation on peripapillary and macular microvasculature measured by optical coherence tomography angiography in healthy individuals. J Curr Ophthalmol 2021; 33:437-443. [PMID: 35128191 PMCID: PMC8772493 DOI: 10.4103/joco.joco_84_21] [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: 03/15/2021] [Revised: 06/11/2021] [Accepted: 06/11/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: To investigate the influence of topical cyclopentolate 1%, as an anti-muscarinic mydriatic agent, on the peripapillary and macular microvasculature by optical coherence tomography angiography (OCT-A) in healthy adults. Methods: A total of 41 healthy adults without any systemic or ocular disease were enrolled for this prospective consecutive study. All patients underwent OCT-A measurements (OptoVue Inc., Freemont, CA, USA) to assess optic disc status for radial peripapillary capillary network (whole image, inside disc, and peripapillary capillary densities), and superficial and deep capillary plexus whole, foveal, parafoveal and perifoveal densities, and foveal avascular zone (FAZ) densities. Foveal retinal thicknesses and all quadrant retinal fiber layer thicknesses were also assessed. The 4.5 mm × 4.5 mm peripapillary and 6 mm × 6 mm macular OCT-A images were undertaken before and 30 min after instillation of topical cyclopentolate 1% to the right eyes. Results: The mean age of subjects was 38.14 ± 14.10 years. All macular, optic disc, and FAZ densities, foveal retinal thicknesses, average, and all quadrant retinal fiber layer thicknesses were statistically similar between baseline and after administration of topical cyclopentolate 1% (P > 0.05). Conclusion: The current study demonstrated that pupillary dilation with topical cyclopentolate 1% seems to have no statistical effect on macular and peripapillary OCT-A measurements of healthy adults.
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Impact of Pupil Dilation on Optical Coherence Tomography Angiography Retinal Microvasculature in Healthy Eyes. J Glaucoma 2020; 29:1025-1029. [PMID: 32890106 PMCID: PMC9933783 DOI: 10.1097/ijg.0000000000001647] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PRéCIS:: Small but significant decreases in optical coherence tomography angiography (OCTA)-measured circumpapillary capillary density (cpCD) were observed in healthy eyes dilated with 2.5% phenylephrine/0.5% tropicamide. Although likely clinically insignificant, ophthalmologists should consider these changes when interpreting OCTA results from dilated eyes. PURPOSE The purpose of this study was to investigate the effect of pupil dilation using 2.5% phenylephrine and 0.5% tropicamide on quantitative assessment of retinal microvasculature using OCTA. METHODS OptoVue AngioVue high density (HD) and non-HD OCTA macula and optic nerve head (ONH) images were obtained at 15-minute intervals predilation and postdilation in 26 healthy participants (mean age: 40.0; 95% confidence interval=33.9, 46.1 y). Superficial macular vessel density (VD) was measured in the whole image VD and the parafoveal region VD. ONH capillary density was measured in the whole image capillary density and the cpCD region. Differences between predilation and postdilation densities were assessed using linear mixed effects models to account for within-patient correlation. RESULTS Instillation of dilating drops resulted in a small but statistically significant reduction in non-HD ONH whole image capillary density of 0.6%, from a mean of 45.2% (95% confidence interval=41.9%, 48.4%) to 44.6% (41.4%, 47.8%) (P=0.046). A similar reduction in non-HD ONH cpCD of 0.8% also was observed, from a mean of 49.3% (45.3%, 53.3%) to 48.5% (44.5%, 52.4%) (P=0.025). No postdilation decreases in macular VD or HD ONH capillary density were observed. CONCLUSIONS Pupil dilation using topical 2.5% phenylephrine and 0.5% tropicamide results in a small but statistically significant reduction in non-HD ONH whole image and cpCD in healthy eyes. The observed reduction likely is not clinically significant because the observed reduction was within the previously reported range of measurement variability. Further studies should consider investigating these effects in nonhealthy eyes with glaucoma and media opacities, as well as older individuals.
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Examination of retinal vascular density changes via optical coherence tomography angiography in patients with glaucoma. Int Ophthalmol 2020; 41:687-698. [PMID: 33094441 DOI: 10.1007/s10792-020-01626-8] [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] [Received: 03/19/2020] [Accepted: 10/17/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of this study was to investigate the changes in vessel density (VD) in glaucoma patients and to investigate the relationship between VD and structural parameters using optical coherence tomography angiography. METHODS Our study included 25 primary open-angle glaucoma (POAG) patients, 25 pseudoexfoliation glaucoma (PXG) patients and 25 healthy individuals. All patients underwent 6 × 6 mm retinal angiography (upper limit: internal limitan membrane [ILM], lower limit: 10 µm inferior to inner plexiform layer) and 4.5 × 4.5 mm disk angiography (upper limit: ILM, lower limit: posterior border of the retinal nerve fiber layer [RNFL]) via an optical coherence tomography (OCT) system (AngioVue, Optovue). Measures of vascular density were as follows: total area VD (tVD), intrapapillary VD (iVD), peripapillary VD (pVD) and parafoveal VD (pfVD). In addition to performing comparisons, the correlations between pVD, retinal nerve fiber layer (RNFL) thickness and optic nerve head measurement results were investigated. RESULTS A total of 75 individuals were included in our study. In the POAG and PXG groups, tVD and pVD values were significantly lower than the control group (median tVDs were: 45.4, 45.9, 50.0, and median pVDs were: 50.0, 50.3, 53.1, respectively) (confidence intervals were: - 9.8/- 1.1 for pVD and - 8.6/- 1.4 for tVD). Significantly lower pf-VD values were detected in the PXG group compared to the control group (p < 0.05). There were strong positive correlations between RNFL thickness and pVD in in glaucoma groups (p < 0.001). There was no correlation between pVD and disk area, intraocular pressure and age in glaucoma patients. Patients using beta-blockers had significantly lower tVD and pVD values compared to those who did not (p < 0.05). CONCLUSION The low VD values in glaucomatous eyes and the strong correlations between that values and RNFL thickness demonstrate a relationship between structural parameters and vascular parameters.
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Szulc U, Dąbrowska E, Pieczyński J, Białkowski P, Narkiewicz K, Schmieder RE, Harazny J. How to measure retinal microperfusion in patients with arterial hypertension. Blood Press 2020; 30:4-19. [PMID: 32969283 DOI: 10.1080/08037051.2020.1823816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Assessment and monitoring of changes in microcirculatory perfusion, perfusion dynamic, vessel structure and oxygenation is crucial in management of arterial hypertension. Constant search for non-invasive methods has led the clinical focus towards the vasculature of the retina, which offers a large opportunity to detect the early phase of the functional and structural changes in the arterial hypertension and can reflect changes in brain vasculature. We review all the available methods of retinal microcirculation measurements including angiography, oximetry, retinal vasculature assessment software, Optical Coherence Tomography Angiography, Adaptive Optics and Scanning Laser Doppler Flowmetry and their application in clinical research. MATERIALS AND METHODS To further analyse the applicability of described methods in hypertension research we performed a systematic search of the PubMed electronic database (April 2020). In our analysis, we included 111 articles in which at least one of described methods was used for assessment of microcirculation of the retina in hypertensive individuals. RESULTS Up to this point, the methods most commonly published in studies of retinal microcirculation in arterial hypertension were Scanning Laser Doppler Flowmetry followed shortly by Optical Coherence Tomography Angiography and retinal vasculature assessment software. CONCLUSIONS While none of described methods enables the simultaneous measurement of all microcirculatory parameters, certain techniques are widely used in arterial hypertension research, while others gain popularity in screening.
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Affiliation(s)
- Urszula Szulc
- Department of Human Physiology and Pathophysiology, University Warmia and Mazury, Olsztyn, Poland
| | - Edyta Dąbrowska
- Department of Hypertension and Diabetology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland.,First Department of Cardiology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Janusz Pieczyński
- Department of Ophthalmology, University Warmia and Mazury, Olsztyn, Poland
| | - Paweł Białkowski
- Department of Ophthalmology, Provincial Specialist Hospital, Olsztyn, Poland
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Roland E Schmieder
- Clinical Research Center, Department of Nephrology and Hypertensiology, University Erlangen-Nuremberg, Erlangen, Germany
| | - Joanna Harazny
- Department of Human Physiology and Pathophysiology, University Warmia and Mazury, Olsztyn, Poland.,Clinical Research Center, Department of Nephrology and Hypertensiology, University Erlangen-Nuremberg, Erlangen, Germany
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The effect of topical tropicamide and phenylephrine on macular and peripapillary microvasculature: an optical coherence tomography angiography study. Int Ophthalmol 2020; 40:1969-1976. [DOI: 10.1007/s10792-020-01371-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 04/10/2020] [Indexed: 12/23/2022]
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Simkiene J, Pranskuniene Z, Vitkauskiene A, Pilvinis V, Boerma EC, Pranskunas A. Ocular microvascular changes in patients with sepsis: a prospective observational study. Ann Intensive Care 2020; 10:38. [PMID: 32266602 PMCID: PMC7138894 DOI: 10.1186/s13613-020-00655-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/24/2020] [Indexed: 12/11/2022] Open
Abstract
Background The aim of the study was to detect differences in the conjunctival microcirculation between septic patients and healthy subjects and to evaluate the course of conjunctival and retinal microvasculature in survivors and non-survivors over a 24-h period of time. Methods This single-center prospective observational study was performed in mixed ICU in a tertiary teaching hospital. We included patients with sepsis or septic shock within the first 24 h after ICU admission. Conjunctival imaging, using an IDF video microscope, and retinal imaging, using portable digital fundus camera, as well as systemic hemodynamic measurements, were performed at three time points: at baseline, 6 h and 24 h. Baseline conjunctival microcirculatory parameters were compared with healthy controls. Results A total of 48 patients were included in the final assessment and analysis. Median APACHE II and SOFA scores were 16[12–21] and 10[7–12], respectively. Forty-four (92%) patients were in septic shock, 48 (100%) required mechanical ventilation. 19 (40%) patients were discharged alive from the intensive care unit. We found significant reductions in all microcirculatory parameters in the conjunctiva when comparing septic and healthy subjects. In addition, we observed a significant lower microvascular flow index (MFI) of small conjunctival vessels during all three time points in non-survivors compared with survivors. However, retinal arteriolar vessels were not different between survivors and non-survivors. Conclusions Conjunctival microvascular blood flow was altered in septic patients. In the 24-h observation period conjunctival small vessels had a significantly higher MFI, but no difference in retinal arteriolar diameter in survivors in comparison with non-survivors. Trial registration NCT04214743, https://www.clinicaltrials.gov. Date of registration: 31 December 2019 – Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04214743
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Affiliation(s)
- Jurate Simkiene
- Department of Intensive Care Medicine, Lithuanian University of Health Sciences, Eiveniu str. 2, Kaunas, 50009, Lithuania
| | - Zivile Pranskuniene
- Department of Drug Technology and Social Pharmacy, Lithuanian University of Health Sciences, Eiveniu str. 2, Kaunas, 50009, Lithuania.,Institute of Pharmaceutical Technologies, Lithuanian University of Health Sciences, Eiveniu str. 2, Kaunas, 50009, Lithuania
| | - Astra Vitkauskiene
- Department of Laboratory Medicine, Lithuanian University of Health Sciences, Eiveniu str. 2, Kaunas, 50009, Lithuania
| | - Vidas Pilvinis
- Department of Intensive Care Medicine, Lithuanian University of Health Sciences, Eiveniu str. 2, Kaunas, 50009, Lithuania
| | - E Christiaan Boerma
- Department of Intensive Care Medicine, Medical Center Leeuwarden, Henri Dunantweg 2, 8901 BR, Leeuwarden, The Netherlands
| | - Andrius Pranskunas
- Department of Intensive Care Medicine, Lithuanian University of Health Sciences, Eiveniu str. 2, Kaunas, 50009, Lithuania.
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