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Tan TE, Ibrahim F, Chandrasekaran PR, Teo KYC. Clinical utility of ultra-widefield fluorescein angiography and optical coherence tomography angiography for retinal vein occlusions. Front Med (Lausanne) 2023; 10:1110166. [PMID: 37359003 PMCID: PMC10285461 DOI: 10.3389/fmed.2023.1110166] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 05/23/2023] [Indexed: 06/28/2023] Open
Abstract
Retinal vein occlusions (RVOs) are the second most common retinal vascular disease after diabetic retinopathy, and are a significant cause of visual impairment, especially in the elderly population. RVOs result in visual loss due to macular ischemia, cystoid macular edema (CME), and complications related to neovascularization. Vascular assessment in RVOs traditionally relies on standard fluorescein angiography (FA) for assessment of macular and retinal ischemia, which aids in prognostication and guides intervention. Standard FA has significant limitations-it is time-consuming, requires invasive dye administration, allows for limited assessment of the peripheral retina, and is usually evaluated semi-qualitatively, by ophthalmologists with tertiary expertise. More recently, the introduction of ultra-widefield FA (UWF FA) and optical coherence tomography angiography (OCTA) into clinical practice has changed the tools available for vascular evaluation in RVOs. UWF FA allows for evaluation of peripheral retinal perfusion, and OCTA is non-invasive, rapidly-acquired, and provides more information on capillary perfusion. Both modalities can be used to provide more quantitative parameters related to retinal perfusion. In this article, we review the clinical utility and impact of UWF FA and OCTA in the evaluation and management of patients with RVOs.
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Affiliation(s)
- Tien-En Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Farah Ibrahim
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | | | - Kelvin Yi Chong Teo
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
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2
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Structural and Visual Changes in Branch Retinal Vein Occlusion Patients with Retinal Atrophy. J Ophthalmol 2022; 2022:8945467. [PMID: 36035899 PMCID: PMC9410836 DOI: 10.1155/2022/8945467] [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: 11/21/2021] [Revised: 06/09/2022] [Accepted: 07/27/2022] [Indexed: 11/17/2022] Open
Abstract
Background To study the changes of retinal vascular density (VD), retinal thickness (RT), and their correlations with visual acuity (VA) in branch retinal vein occlusion (BRVO) patients with retinal atrophy after resolution of macular oedema (MO). Methods This is a retrospective study consisting of 46 patients diagnosed with BRVO at Beijing Hospital from 2015 to 2019. Patients' 46 affected eyes and 39 fellow eyes were included. The affected eyes were further divided into the atrophy group and the nonatrophy group. Optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) images obtained when MO completely resolved after treatment with ranibizumab were analyzed. We quantitatively measured foveal avascular zone (FAZ) parameters, the disruption extent of ellipsoid zone (EZ), RT, and VD of superficial vascular complex (SVC), and deep vascular complex (DVC) in central fovea and the minimal-VD quadrant. Paired t-tests, independent t-tests, Mann–Whitney U tests, Wilcoxon tests, Pearson correlation analyses, Spearman correlation analyses, and single and multiple linear regression models were adopted. Results Compared with nonatrophy eyes, the minimal-VD quadrantal (quadrantal for short) SVC-VD (25.76 ± 4.57% versus 36.21 ± 6.47%, P < 0.001) and quadrantal DVC-VD (27.72 (17.23) % versus 38.95 (11.05) %, P = 0.001) of atrophy eyes decreased significantly. Quadrantal SVC-VD and quadrantal DVC-VD were strongly correlated with quadrantal full RT (r = 0.763 and 0.698, both P < 0.001). The disruption length of EZ was significantly correlated with quadrantal full RT (r = −0.406, P = 0.005) and quadrantal SVC-VD (r = −0.298, P = 0.044). In multiple linear regression analysis, the disruption length of EZ and VA before treatment and age showed significant correlations with VA with complete resolution of MO (P = 0.020, 0.033, and 0.002). Conclusions The retinal VD on the affected area correlates well with the corresponding full RT when BRVO-MO completely resolves, suggesting that VD may predict the final RT. Severe decrease in VD may result in retinal atrophy, which may cause VA loss indirectly with the intermediate influencing factor of EZ defects.
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Araki S, Sakimoto S, Shiozaki D, Ueda C, Hara C, Fukushima Y, Sayanagi K, Sakaguchi H, Nishida K. Microvascular Changes in the Cystic Lesion of Branch Retinal Vein Occlusion Imaged by Swept-Source Optical Coherence Tomography Angiography. Biomed Hub 2022; 7:99-105. [PMID: 36262676 PMCID: PMC9574207 DOI: 10.1159/000525497] [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: 01/19/2022] [Accepted: 05/03/2022] [Indexed: 11/19/2022] Open
Abstract
<b><i>Introduction:</i></b> This study aimed to describe the quantitative features of the microvasculature in the cystic lesions of branch retinal vein occlusion (BRVO). <b><i>Methods:</i></b> A total of 43 eyes with BRVO, treated with anti-vascular endothelial growth factor therapy, were analyzed. Using wide-field swept-source optical coherence tomography angiography (OCTA), en face OCT images were obtained by depth-integrated reflectivity of the retina, and vascular density (VD), vascular length (VL), vascular lacunarity, and fractal dimension (FD) were evaluated in a 12 × 12-mm area of retinal nonperfusion. <b><i>Results:</i></b> The mean area of affected lesions was 38.7 ± 19.8 mm<sup>2</sup>, and cystic lesions were 8.5 ± 10.1 mm<sup>2</sup>. VD, VL, and FD were significantly decreased in the cystic lesions compared to other affected lesions in the same eyes (<i>p</i> = 0.0010, <i>p</i> = 0.0001, and <i>p</i> = 0.0003, respectively) and in all eyes (<i>p</i> = 0.0281, <i>p</i> = 0.0050, and <i>p</i> < 0.0001, respectively). VD in cystic lesions within the vascular arcade (25 eyes) correlated with best-corrected visual acuity on OCTA (<i>r</i> = −0.433, and <i>p</i> = 0.0492). <b><i>Conclusions:</i></b> Vascular structure in the cystic lesions was unpreserved compared to the other lesions in BRVO. These findings may help in understanding the pathophysiology of retinal edema in BRVO.
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Affiliation(s)
- Satoko Araki
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Susumu Sakimoto
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives, Osaka University, Suita, Japan
- *Susumu Sakimoto,
| | - Daiki Shiozaki
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Chihiro Ueda
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Chikako Hara
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yoko Fukushima
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives, Osaka University, Suita, Japan
| | - Kaori Sayanagi
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hirokazu Sakaguchi
- Department of Ophthalmology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kohji Nishida
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives, Osaka University, Suita, Japan
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Sasajima H, Tsuboi K, Kiyosawa R, Fukutomi A, Murotani K, Kamei M. Smooth borders between inner nuclear layer and outer plexiform layer predict fewer macular edema recurrences in branch retinal vein occlusion. Sci Rep 2021; 11:15987. [PMID: 34362985 PMCID: PMC8346557 DOI: 10.1038/s41598-021-95501-w] [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: 04/21/2021] [Accepted: 07/27/2021] [Indexed: 11/24/2022] Open
Abstract
We hypothesized the smoothness of the border between the inner nuclear layer (INL) and outer plexiform layer (OPL) associates with the frequency of macular edema (ME) recurrences secondary to branch retinal vein occlusion (BRVO). Thirty-seven consecutive eyes with BRVO treated with anti-vascular endothelial growth factor (VEGF) injections at 1-year follow-up were included. We manually traced the border between the INL and OPL within the 1.5-mm vertical line from the fovea on optical coherence tomography (OCT) images at the initial visit. The jagged ratio (JR), the border length divided by the spline curve length, was calculated. We performed univariate and multivariate regression analyses, including JR, patient characteristics, number of cystoid spaces in the INL, INL area, and outer retina area. Multivariate regression analysis showed JR significantly correlates with the total number of anti-VEGF injections (P < 0.0001). Moreover, the mean JR was significantly lower in the nine eyes receiving two or fewer injections than in the 28 eyes receiving three or more injections (1.02 ± 0.01 vs. 1.13 ± 0.06, P < 0.0001). A smooth border between the INL and the OPL on OCT images at the initial visit may be a biomarker for fewer ME recurrences in eyes with BRVO.
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Affiliation(s)
- Hirofumi Sasajima
- Department of Ophthalmology, Shinseikai Toyama Hospital, Imizu, Toyama, Japan.
| | - Kotaro Tsuboi
- Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi, Japan.,Casey Eye Institute, Oregon Health & Science University, Portland, USA
| | - Rokuki Kiyosawa
- Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi, Japan
| | - Akira Fukutomi
- Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi, Japan
| | - Kenta Murotani
- Biostatistics Center, Graduate School of Medicine, Kurume University, Fukuoka, Japan
| | - Motohiro Kamei
- Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi, Japan
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Association of disorganization of retinal inner layers with optical coherence tomography angiography features in branch retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol 2021; 259:2897-2903. [PMID: 33861366 DOI: 10.1007/s00417-021-05168-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 01/29/2021] [Accepted: 03/19/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To examine the associations between the disorganization of the retinal inner layers (DRIL) and optical coherence tomography angiography characteristics and visual acuity (VA) outcomes in eyes with macular edema secondary to branch retinal vein occlusion (BRVO). METHODS In this single-center cross-sectional cohort study, the data of 43 patients with macular edema secondary to BRVO that received pro re nata anti-vascular endothelial growth factor therapy were analyzed. B-scan and en face angiographic images were obtained by swept-source-based wide-field optical coherence tomography angiography performed at a single visit 1 month after the anti-vascular endothelial growth factor therapy session and evaluated. Correlations between the vascular indices in macula-centered 3 × 3 and 12 × 12 mm2 areas and B-scan parameters, such as DRIL length and VA, were examined. RESULTS The mean DRIL length (Rs = 0.588, p < 0.001) and the proportion of scans with DRIL out of five scans (Rs = 0.507, p = 0.001) were significantly correlated with the final best-corrected VA in patients with BRVO. DRIL length was associated with vascular density (VD) and vascular length in the macula (Rs = - 0.425, p = 0.006 and Rs = - 0.382, p = 0.013, respectively), but not with VD and vascular length in the larger areas (12 × 12 mm2). Multilinear regression analysis revealed that the extent of macular edema (p = 0.0016) and VD in the 3 × 3 mm2 area (p = 0.004) was significantly associated with the DRIL development. CONCLUSION DRIL severity was correlated with VA and associated with the peri-macular perfusion status in eyes with BRVO. Macular edema and macular perfusion affected DRIL severity. These findings would help understand the pathogenesis of DRIL in eyes with BRVO.
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Murata T, Kondo M, Inoue M, Nakao S, Osaka R, Shiragami C, Sogawa K, Mochizuki A, Shiraga R, Ohashi Y, Kaneko T, Chandrasekhar C, Tsujikawa A, Kamei M. The randomized ZIPANGU trial of ranibizumab and adjunct laser for macular edema following branch retinal vein occlusion in treatment-naïve patients. Sci Rep 2021; 11:551. [PMID: 33436683 PMCID: PMC7804316 DOI: 10.1038/s41598-020-79051-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 12/04/2020] [Indexed: 11/09/2022] Open
Abstract
The ZIPANGU study assessed the efficacy and safety of ranibizumab as a one loading dose + pro re nata (one + PRN) regimen with/without focal/grid laser among treatment-naïve patients suffering from macular edema (ME) following branch retinal vein occlusion (BRVO). ZIPANGU was a phase IV, prospective, randomized, open-label, active-controlled, 12-month, two-arm, multicenter study. Treatment-naïve patients with visual impairment (19–73 letters) caused by ME, defined as central subfield thickness (CSFT) > 300 µm, due to BRVO were randomly assigned to ranibizumab monotherapy (n = 29) or combination therapy (ranibizumab + focal/grid short-pulse laser, n = 30). The primary endpoint was the number of ranibizumab injections. Secondary endpoints were mean changes in best-corrected visual acuity (BCVA) and CSFT, and safety. There were no statistically significant differences in the mean number of ranibizumab injections between monotherapy (4.3 injections) vs. combination (4.1 injections) therapy, or in CSFT. BCVA improvement in the monotherapy arm (22.0 letters) was better than the combination therapy arm (15.0 letters) (p = 0.035). Overall, both regimens appeared to be safe and well tolerated. One + PRN ranibizumab is safe and efficacious in treatment-naïve patients with ME secondary to BRVO. A conjunctive laser treatment did not lead to better functional outcomes or fewer ranibizumab injections.
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Affiliation(s)
- Toshinori Murata
- Department of Ophthalmology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, Japan.
| | - Mineo Kondo
- Department of Ophthalmology, Mie University Graduate School of Medicine, Mie, Japan
| | - Makoto Inoue
- Department of Ophthalmology, Kyorin Eye Center, Kyorin University School of Medicine, Tokyo, Japan
| | - Shintaro Nakao
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Rie Osaka
- Department of Ophthalmology, Kagawa University Faculty of Medicine, Kagawa, Japan
| | - Chieko Shiragami
- Department of Ophthalmology, Kagawa University Faculty of Medicine, Kagawa, Japan
| | - Kenji Sogawa
- Department of Ophthalmology, Asahikawa Medical University, Hokkaido, Japan
| | | | | | | | | | | | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Motohiro Kamei
- Department of Ophthalmology, Aichi Medical University, Aichi, Japan
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Ryu G, Noh D, van Hemert J, Sadda SR, Sagong M. Relationship between distribution and severity of non-perfusion and cytokine levels and macular thickness in branch retinal vein occlusion. Sci Rep 2021; 11:271. [PMID: 33432033 PMCID: PMC7801443 DOI: 10.1038/s41598-020-79522-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/06/2020] [Indexed: 11/28/2022] Open
Abstract
We aimed to investigate the relationship between non-perfusion on ultra-widefield angiography (UWF FA) and aqueous cytokine levels and central macular thickness (CMT) in eyes with branch retinal vein occlusion (BRVO). Thirty-five eyes with treatment-naïve BRVO were included. Non-perfusion area (NPA) for partial and complete ischemia was manually segmented and the ischemic index (ISI) for each was calculated using stereographically projected UWF FA for four different retinal zones. Partial and complete ischemia had different regional predominance. Partial ischemia was predominant in the posterior regions, while complete ischemia was predominant in the periphery. And partial ischemic area, located posterior to far periphery, showed significant correlation with central macular thickness and concentrations of angiogenic and inflammatory cytokines, while complete ischemic area showed no correlation with any of the parameters. Taken together, partial but not complete ischemia, particularly in the more posterior retina, was associated with higher cytokine levels and more severe macular edema in eyes with BRVO. These findings would help us to better understand the different clinical significance of ischemia in BRVO depending on the severity and regional distribution.
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Affiliation(s)
- Gahyung Ryu
- Department of Ophthalmology, Yeungnam University College of Medicine, #170 Hyunchungro, Nam-gu, Daegu, 42415, South Korea.,Yeungnam Eye Center, Yeungnam University Hospital, Daegu, South Korea
| | - Donghyoun Noh
- Department of Ophthalmology, Yeungnam University College of Medicine, #170 Hyunchungro, Nam-gu, Daegu, 42415, South Korea.,Good Doctors Eye Hospital, Ulsan, South Korea
| | | | - SriniVas R Sadda
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, CA, USA.,Department of Ophthalmology, David Geffen School of Medicine At UCLA, Los Angeles, CA, USA
| | - Min Sagong
- Department of Ophthalmology, Yeungnam University College of Medicine, #170 Hyunchungro, Nam-gu, Daegu, 42415, South Korea. .,Yeungnam Eye Center, Yeungnam University Hospital, Daegu, South Korea.
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8
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Jang JH, Kim YC, Shin JP. Correlation between macular edema recurrence and macular capillary network destruction in branch retinal vein occlusion. BMC Ophthalmol 2020; 20:341. [PMID: 32831053 PMCID: PMC7444240 DOI: 10.1186/s12886-020-01611-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 08/14/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The aim of this study was to evaluate the correlation between changes in the macular capillary network and macular edema (ME) recurrence with branch retinal vein occlusion (BRVO) using swept-source optical coherence tomography angiography (SS-OCTA). METHODS We reviewed the data for 43 patients with treatment-naïve ME associated with BRVO. Patients who received intravitreal bevacizumab injection were divided into two groups based on ME recurrence at 6 months after edema resolution. The perifoveal capillary morphology and the macular capillary vessel density (VD) were retrospectively analyzed using en face SS-OCTA after ME resolution. RESULTS The perifoveal capillary ring loss in the superficial capillary plexus (SCP) and deep capillary plexus (DCP) was more common in the ME recurrence group (n = 22) than in the no ME recurrence group (p = 0.047 and p = 0.002). Relative to the findings in the no ME recurrence groups, the destruction of the perifoveal capillary ring was more severe in the DCP (30.0° vs 87.3°, p = 0.001) than in the SCP (17.3° vs 69.5°, p = 0.006) in the ME recurrence group. The hemi-VD disparity between the affected and the unaffected areas in the SCP and DCP showed significant differences (p = 0.031 and p = 0.017), while macular VD showed no differences between the groups. CONCLUSIONS Destruction of the perifoveal capillary ring and hemi-VD disparity could be related to ME recurrence in BRVO. Therefore, these factors may be helpful in predicting ME recurrence.
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Affiliation(s)
- Ji Hye Jang
- Department of Ophthalmology, Keimyung Universtiy School of Medicine, Daegu, Republic of Korea. .,Keimyung University Institute for Medical Science, Daegu, Republic of Korea.
| | - Yu Cheol Kim
- Department of Ophthalmology, Keimyung Universtiy School of Medicine, Daegu, Republic of Korea
| | - Jae Pil Shin
- Department of Ophthalmology, Kyungpook National University School of Medicine, Daegu, Republic of Korea
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9
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Correlation between macular vessel density and number of intravitreal anti-VEGF agents for macular edema associated with branch retinal vein occlusion. Sci Rep 2019; 9:16388. [PMID: 31705014 PMCID: PMC6841709 DOI: 10.1038/s41598-019-52732-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/22/2019] [Indexed: 12/28/2022] Open
Abstract
We evaluated whether the reduction of macular vessel density was correlated with the number of intravitreal injections of anti-vascular endothelial growth factor (VEGF) agents in eyes with a branch retinal vein occlusion (BRVO). The mean vessel density was determined by optical coherence tomography angiography in 29 eyes with macular edema associated with a BRVO. Our results showed that the mean vessel density in the group that had a resolution of the macular edema after one anti-VEGF injection was significantly higher than group that had a recurrence of the macular edema (P = 0.028). Single regression analysis showed that the number of intravitreal injections was significantly correlated with the reduction of the modified vessel density (r = −0.421, P = 0.023) and systemic hypertension (r = 0.377, P = 0.044). Multiple stepwise regression analysis showed that the reduction of the modified vessel density (β = −0.442, P = 0.009) and hypertension (β = 0.403, P = 0.016) were independent factors associated with the number of intravitreal injections. We conclude that the vessel density reduction can be used to predict whether recurrences of the macular edema will develop after the initial anti-VEGF injection in eyes with macular edema associated with a BRVO.
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10
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Nicolai M, Franceschi A, Turris SD, Rosati A, Pirani V, Mariotti C. Papillary Vessel Density Changes After Intravitreal Anti-VEGF Injections in Hypertensive Patients with Central Retinal Vein Occlusion: An Angio-OCT Study. J Clin Med 2019; 8:jcm8101636. [PMID: 31590449 PMCID: PMC6832619 DOI: 10.3390/jcm8101636] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 09/30/2019] [Accepted: 10/02/2019] [Indexed: 12/12/2022] Open
Abstract
Purpose: To investigate papillary microvascular changes in patients affected by macular edema due to Central Retinal Vein Occlusions (CRVO) after anti-Vascular Endothelial Growth Factor (VEGF) therapy. Methods: Prospective analysis of papillary and peripapillary vessel density (VD) changes in 18 eyes of 18 hypertensive patients affected by CRVO before and after the loading-phase of intravitreal Ranibizumab (IVR) injections. Data were quantitatively measured by optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) before as well as 1 month and 4 months after injections. The correlation between post-treatment best-corrected visual acuity (BCVA) and changes in the retinal microvasculature evaluated by OCTA was assessed. Results: 18 eyes of 18 consecutive patients with a known history of arterial hypertension and affected by an acute CRVO episode were enrolled. Central macular thickness (CMT) was significantly reduced after IVR injections (p < 0.001), while mean BCVA improved from 0.70 ± 0.26 logarithm of the minimal angle of resolution (logMAR) units at baseline to 0.25 ± 0.18 logMAR units after 4 months (p < 0.001). VD inside disc and peripapillary significantly increased (p < 0.001 and p = 0.01, respectively) after treatment. Conclusions: OCTA showed VD increase in the papillary area in patients affected by CRVO after anti-VEGF therapy. This area could represent a new region of interest to study microvasculature changes concomitant with severe macular edema.
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Affiliation(s)
- Michele Nicolai
- Eye Clinic, Polytechnic University of Marche, via Conca 61, 60126, Ancona, Italy.
| | | | - Serena De Turris
- Eye Clinic, Polytechnic University of Marche, via Conca 61, 60126, Ancona, Italy.
| | - Alessandro Rosati
- Eye Clinic, Polytechnic University of Marche, via Conca 61, 60126, Ancona, Italy.
| | - Vittorio Pirani
- Eye Clinic, Polytechnic University of Marche, via Conca 61, 60126, Ancona, Italy.
| | - Cesare Mariotti
- Eye Clinic, Polytechnic University of Marche, via Conca 61, 60126, Ancona, Italy.
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11
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Spatial statistical modelling of capillary non-perfusion in the retina. Sci Rep 2017; 7:16792. [PMID: 29196702 PMCID: PMC5711887 DOI: 10.1038/s41598-017-16620-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 11/10/2017] [Indexed: 11/21/2022] Open
Abstract
Manual grading of lesions in retinal images is relevant to clinical management and clinical trials, but it is time-consuming and expensive. Furthermore, it collects only limited information - such as lesion size or frequency. The spatial distribution of lesions is ignored, even though it may contribute to the overall clinical assessment of disease severity, and correspond to microvascular and physiological topography. Capillary non-perfusion (CNP) lesions are central to the pathogenesis of major causes of vision loss. Here we propose a novel method to analyse CNP using spatial statistical modelling. This quantifies the percentage of CNP-pixels in each of 48 sectors and then characterises the spatial distribution with goniometric functions. We applied our spatial approach to a set of images from patients with malarial retinopathy, and found it compares favourably with the raw percentage of CNP-pixels and also with manual grading. Furthermore, we were able to quantify a biological characteristic of macular CNP in malaria that had previously only been described subjectively: clustering at the temporal raphe. Microvascular location is likely to be biologically relevant to many diseases, and so our spatial approach may be applicable to a diverse range of pathological features in the retina and other organs.
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12
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Fuma S, Nishinaka A, Inoue Y, Tsuruma K, Shimazawa M, Kondo M, Hara H. A pharmacological approach in newly established retinal vein occlusion model. Sci Rep 2017; 7:43509. [PMID: 28252108 PMCID: PMC5333144 DOI: 10.1038/srep43509] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 01/25/2017] [Indexed: 11/09/2022] Open
Abstract
The mechanism underlying the effects of anti-vascular endothelial growth factor (VEGF) antibody in retinal vein occlusion (RVO) treatment is poorly understood, partly due to the lack of RVO animal models that mimic clinical pathology. The aims of this study were to establish a suitable RVO model, clarify the pathogenic mechanisms, and evaluate the effects of anti-VEGF antibody in the model. Mouse retinal veins were occluded by laser photocoagulation after rose bengal injection. Reduction of the b/a wave amplitude ratio, retinal nonperfusion, cystoid edema, and hard exudates were observed after occlusion, and expression of RVO-related genes was altered. Administration of anti-VEGF antibody immediately, or 7 days, after occlusion resulted in reduction and increase of the nonperfused area, respectively. We conclude that the present model will be useful for clarification of the pathogenic mechanisms, and that the timing of anti-VEGF antibody administration is important for the successful amelioration of retinal nonperfusion.
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Affiliation(s)
- Shinichiro Fuma
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
| | - Anri Nishinaka
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
| | - Yuki Inoue
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
| | - Kazuhiro Tsuruma
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
| | - Masamitsu Shimazawa
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
| | - Mineo Kondo
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hideaki Hara
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
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Sakimoto S, Kamei M, Sakaguchi H, Suzuki M, Matsumura N, Nishida K, Nishida K. Direct photocoagulation to leakage points to treat chronic macular edema associated with branch retinal vein occlusion: a pilot study. Clin Ophthalmol 2014; 8:2055-60. [PMID: 25336905 PMCID: PMC4199790 DOI: 10.2147/opth.s66878] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Summary statement Direct photocoagulation reduces the central foveal thickness (CFT) in cases with chronic branch retinal vein occlusion (BRVO) of longer than 12 months duration. Photo-coagulation might be effective for chronic macular edema due to branch retinal vein occlusion. Background The aim was to investigate the effect of direct photocoagulation for treating chronic macular edema associated with BRVO. Methods This study was a noncomparative, pilot interventional case series. We examined the CFT and best-corrected visual acuity over 6 months in patients with BRVO treated with direct photocoagulation. Results Sixteen eyes of 16 patients had been treated with direct photocoagulation (mean follow-up period, 20.5 months). The mean CFT decreased significantly (P<0.001) between the baseline (465 μm) and the final visit (304 μm). The mean (logarithm of the minimum angle of resolution equivalent) best-corrected visual acuity at the baseline was 0.39 and improved significantly (P<0.001) to 0.20 at the final visit. Conclusion Direct photocoagulation to leakage points is beneficial for treating chronic macular edema associated with chronic BRVO of longer than 12 months duration.
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Affiliation(s)
- Susumu Sakimoto
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Motohiro Kamei
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hirokazu Sakaguchi
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Mihoko Suzuki
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Nagakazu Matsumura
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Kentaro Nishida
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Kohji Nishida
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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