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Gobeka HH, Mentes J, Nalcaci S, Oztas Z, Cay Y. Morphological integrity of the outer retinal layers and visual prognosis in chronic central serous chorioretinopathy after half-dose photodynamic therapy: a qualitative SD-OCT analysis. Lasers Med Sci 2022; 38:9. [PMID: 36539551 DOI: 10.1007/s10103-022-03676-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 10/17/2022] [Indexed: 12/24/2022]
Abstract
The study aims to investigate the morphological integrity of the outer retinal layers (ORLs) (an ellipsoid layer (EL) + external limiting membrane) and visual prognosis in chronic central serous chorioretinopathy (CSCR) with subretinal fluid (SRF) completely resorbed after half-dose photodynamic therapy (HD PDT) using enhanced-depth imaging (EDI) spectral domain optical coherence tomography (SD-OCT). This retrospective study included 40 eyes of 38 chronic CSCR patients treated with HD PDT between December 2012 and June 2016. However, only 34 eyes (85%) with complete SRF resorption 3 months after HD PDT had their 6th and 12th month data analyzed. Morphological integrity of the ORLs was further analyzed in relation to best-corrected visual acuity (BCVA) and disease duration. Thirty-four eyes of 34 patients (male/female: 82.35/17.65%) with mean age of 49.90 ± 7.80 (32-61) years were studied. The mean logMAR BCVA improved significantly from 0.52 ± 0.31 at baseline to 0.34 ± 0.36 and 0.26 ± 0.26 at the 6th and 12th months after HD PDT, respectively (p < 0.001). The proportion of eyes with completely normal morphological ultrastructural integrity of the ORLs was 44.12% at the 6th month, which increased to 64.71% at the 12th month after HD PDT. However, the EL morphological disruption was associated with significantly lower mean logMAR BCVA 12 months after HD PDT (p = 0.029). The disease duration had no effect on mean logMAR BCVA gain. Even after complete resorption of serous neurosensory retinal detachment after HD PDT in chronic CSCR, the ORLs, especially the EL, may not be anatomically restored. The EL morphological ultrastructural integrity seems to be the most important factor influencing visual prognosis.
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Affiliation(s)
- Hamidu Hamisi Gobeka
- Department of Ophthalmology, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey.
- Department of Ophthalmology, Faculty of Medicine, Ege University, Izmir, Turkey.
| | - Jale Mentes
- Department of Ophthalmology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Serhad Nalcaci
- Department of Ophthalmology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Zafer Oztas
- Department of Ophthalmology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Yigit Cay
- Department of Ophthalmology, Faculty of Medicine, Ege University, Izmir, Turkey
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Correlation of Photoreceptor Integrity with Retinal Vessel Density and Choriocapillaris in Eyes with Diabetic Retinopathy. Retina 2021; 42:434-441. [PMID: 34743130 DOI: 10.1097/iae.0000000000003343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate the correlation of foveal photoreceptor integrity with the vessel density (VD) of the retina and choriocapillaris using swept-source optical coherence tomography (OCT) angiography (OCTA) in eyes with diabetic retinopathy (DR). METHODS We retrospectively reviewed subjects having eyes with DR, who underwent OCTA using swept-source OCT (DRI OCT Triton; Topcon). We analyzed the area of the foveal avascular zone (FAZ) and VDs of the superficial capillary plexus (SCP), deep capillary plexus (DCP), and choriocapillaris. The length of the lateral extent of ellipsoid zone (EZ) disruption, central subfield thickness, and subfoveal choroidal thickness were measured. Furthermore, we analyzed factors that were closely associated with the length of EZ disruption. RESULTS A total of 159 eyes with DR and 30 healthy control eyes were included in this study. In all eyes, the lengths of EZ disruption were positively correlated with the FAZ area (P=0.009). However, they were negatively correlated with the parafoveal VD of the SCP (P=0.049), the foveal VD of DCP (P=0.003), and that of the choriocapillaris (P=0.036). CONCLUSIONS The size of the FAZ and ischemia at the DCP may play an important role in maintaining foveal photoreceptor integrity in eyes with DR. Considering OCTA artifacts, such as projection and shadowing, future studies are required to reveal the correlation between EZ disruption and the VD of the choriocapillaris.
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Kessler LJ, Auffarth GU, Bagautdinov D, Khoramnia R. Ellipsoid Zone Integrity and Visual Acuity Changes during Diabetic Macular Edema Therapy: A Longitudinal Study. J Diabetes Res 2021; 2021:8117650. [PMID: 34660813 PMCID: PMC8516551 DOI: 10.1155/2021/8117650] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/06/2021] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Ellipsoid zone (EZ) integrity is identified as a potential biomarker for therapy surveillance and outcome prediction of visual acuity (VA). However, only a few studies report long-term results of over 1 year of clinical and anatomical changes in patients with diabetic macular edema (DME). This study is aimed at describing the long-term VA and anatomical outcomes in spectral domain optical coherence tomography (OCT) (relative ellipsoid zone reflectivity ratio, central macular thickness, and volume) in patients with DME treated with antivascular endothelial growth factor (anti-VEGF) therapy. Furthermore, we studied the correlation between EZ integrity and changes in visual acuity. METHODS 71 eyes of 71 patients were included in this retrospective study. Clinical characteristics were reviewed yearly. OCT data were assessed at baseline and after 1, 3, and 5 years. EZ parameters were quantified automatically. OCT parameters and visual outcome were correlated and analyzed in multivariable regression models. RESULTS EZ reflectivity ratio correlated with functional outcome in DME patients from baseline to fifth year at all time points (for all p < 0.05). EZ reflectivity improved the most in the first year of treatment (0.68 to 0.75; p < 0.05) and declined gradually until year 5 of therapy (0.71; compared to baseline p > 0.05). Similarly, best VA was achieved after 1 year (0.40 logarithm of the minimum angle of resolution (logMAR) to 0.28 logMAR; p < 0.001) and declined gradually until year 5. Final VA in year 5 was comparable to baseline (0.45 logMAR, compared to baseline p > 0.05). Together with baseline VA, baseline EZ parameters did predict VA outcome after 1 year (p < 0.05). Concordantly, VA and EZ parameters from year 1 were associated with VA outcome in year 2. CONCLUSION This study described the long-term course of EZ changes during anti-VEGF treatment in DME patients. In addition, our results underlined the potential of EZ parameters as novel OCT biomarkers for prediction of VA outcomes during therapy.
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Affiliation(s)
- Lucy J. Kessler
- Department of Ophthalmology, University of Heidelberg, Heidelberg 69120, Germany
- HEiKA–Heidelberg Karlsruhe Strategic Partnership, Heidelberg University and Karlsruhe Institute of Technology (KIT), Karlsruhe 76131, Germany
| | - Gerd U. Auffarth
- Department of Ophthalmology, University of Heidelberg, Heidelberg 69120, Germany
| | - Dmitrii Bagautdinov
- Department of Ophthalmology, University of Heidelberg, Heidelberg 69120, Germany
| | - Ramin Khoramnia
- Department of Ophthalmology, University of Heidelberg, Heidelberg 69120, Germany
- HEiKA–Heidelberg Karlsruhe Strategic Partnership, Heidelberg University and Karlsruhe Institute of Technology (KIT), Karlsruhe 76131, Germany
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Eraslan S, Yıldırım Ö, Dursun Ö, Dinç E, Orekici Temel G. Relationship Between Final Visual Acuity and Optical Coherence Tomography Findings in Patients with Diabetic Macular Edema Undergoing Anti-VEGF Therapy. Turk J Ophthalmol 2021; 50:163-168. [PMID: 32631004 PMCID: PMC7338745 DOI: 10.4274/tjo.galenos.2019.91962] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objectives: To identify the prevalence of findings in optical coherence tomography (OCT) sections before intravitreal anti-VEGF treatment in patients with diabetic macular edema (DME), and to evaluate the relationship between these findings and final visual acuity and number of injections. Materials and Methods: This retrospective study included 296 eyes of 191 patients (104 male, 87 female) who started intravitreal ranibizumab treatment after being diagnosed with DME in the retina unit between January 2013 and April 2017 were included the study. Spectral domain OCT findings at the time of presentation such as presence of serous macular detachment (SD), vitreomacular traction (VMT), and epiretinal membrane (ERM) were recorded. In addition, the regularity of the ellipsoid zone (EZ) and inner retinal layers was also studied. Results: The mean central retinal thickness measured in SD-OCT was 449±81 μm before treatment and 350±96 μm after treatment (p<0.001). SD was detected in 155 eyes (52.4%), ERM in 67 eyes (22.6%), and VMT in 9 eyes (3%). Thirty eyes (10.1%) had disorganization of the retinal inner layers (DRIL) and 54 eyes (18.2%) had EZ deterioration. The presence of ERM, EZ irregularity, and DRIL were associated with significantly lower final visual acuity (p<0.0001), while there was no relationship between pre-treatment SD and final visual acuity (p=0.11). Injection number was higher in eyes with SD and ERM compared to those without, but this difference was statistically significant only in the presence of SD (p=0.01 and p=0.59, respectively). There was no difference in injection number according to EZ irregularity or presence of DRIL. Conclusion: The coexistence of SD with DME was associated with increased need for treatment but not with final visual acuity. EZ irregularities, DRIL, and ERM are findings that negatively affect visual acuity.
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Affiliation(s)
- Seher Eraslan
- Nevşehir State Hospital, Clinic of Ophthalmology, Nevşehir, Turkey
| | - Özlem Yıldırım
- Mersin University Faculty of Medicine, Department of Ophthalmology, Mersin, Turkey
| | - Özer Dursun
- Mersin University Faculty of Medicine, Department of Ophthalmology, Mersin, Turkey
| | - Erdem Dinç
- Mersin University Faculty of Medicine, Department of Ophthalmology, Mersin, Turkey
| | - Gülhan Orekici Temel
- Mersin University Faculty of Medicine, Department of Biostatistics, Mersin, Turkey
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Tsai MJ, Cheng CK. Patterns of ellipsoid zone change associated with visual outcome for diabetic macular oedema. Clin Exp Optom 2021; 105:48-54. [PMID: 33780648 DOI: 10.1080/08164622.2021.1896333] [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: 12/14/2022] Open
Abstract
Clinical relevance: Optical coherence tomography biomarkers are dynamic and possibly change over time. The dynamic biomarkers may better predict improvement of final vision than those at baseline for diabetic macular oedema after treatment.Background: To investigate predictors for ellipsoid zone (EZ) dynamics and the association with visual acuity after treatment for diabetic macular oedemaMethods: A total of 135 eyes from 135 patients with anti-vascular endothelial growth factor treatment for diabetic macular oedema were retrospectively enrolled in this study. EZ status was evaluated by optical coherence tomography at baseline, 1, 3, 6, and 12 months post-operatively. Macular perfusion status was analysed by fluorescein angiography. Duration of EZ disruption was quantified by giving scores from 0 to 5 based on the sum of visits with evidence of EZ disruption. Linear regression models were used to predict factors for scores of EZ disruption. Binary logistic regression was used to predict various EZ biomarkers for final visual acuity improvement.Results: Thirty of 87 eyes (34.4%) with intact EZ at baseline developed subsequent EZ disruption. For those with EZ disruption at baseline, 17 of 48 (35.4%) patients had restoration of disrupted EZ over time. Non-perfused macula was associated with both earlier development of EZ disruption and poor restoration (p < 0.001 and p = 0.011, respectively). Non-perfused macula, absence of epiretinal membrane, and EZ disruption at baseline predicted higher EZ scores (p < 0.001, p = 0.022 and p < 0.001, respectively). Higher EZ scores (p = 0.016), but not baseline EZ disruption (p = 0.56), were less likely to have improvement of final vision 5 letters or more.Conclusion: Macular perfusion status played an independent role in EZ dynamics. Duration of EZ disruption could be more predictive than baseline status for improvement of vision over 12 months.
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Affiliation(s)
- Meng-Ju Tsai
- Department of Ophthalmology, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Cheng-Kuo Cheng
- Department of Ophthalmology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.,Department of Medicine, School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
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Sharef N, Kassem R, Hecht I, Bar A, Maharshak I, Burgansky-Eliash Z, Weinberger Y, Tuuminen R, Achiron A. Interdigitation and Ellipsoid Zones Disruption Correlate with Visual Outcomes among Treatment-Naive Patients with Diabetic Macular Edema. Ophthalmic Res 2020; 64:476-482. [PMID: 33221809 DOI: 10.1159/000513204] [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: 06/30/2020] [Accepted: 11/06/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We have recently shown that defects in interdigitation and ellipsoid zones (IZ and EZ) can predict response to anti-VEGF therapy in a small group of treatment-naive diabetic macular edema (DME) patients. The aim of the current study is to further evaluate this association in a larger study group of patients over a longer follow-up time. METHODS Thirty eyes of 30 treatment-naive DME patients were analyzed in this retrospective study. The integrity of foveal IZ and EZ was evaluated using optical coherence tomography at the diagnosis of DME and following anti-VEGF injections. The defect size was correlated with best-corrected visual acuity (BCVA) and central macular thickness (CMT). RESULTS The mean patients' age at baseline was 63.0 ± 10.0 years. Patients underwent 3.9 ± 2.9 anti-VEGF injections for a mean of 9.1 ± 4.8 months. Following treatment, the mean Snellen visual acuity (VA) improved from 20/52 to 20/44 (p = 0.05), CMT decreased from 432.5 ± 141.4 μm to 375.2 ± 121.4 µm (p = 0.05) and IZ/EZ defect size decreased from 259.83 ± 375.94 µm to 65.34 ± 143.97 µm (p = 0.001). In patients with no IZ/EZ defects at baseline, the mean Snellen VA was better when compared to those with IZ/EZ defects (20/36 vs. 20/70, p = 0.031). The number of eyes with IZ/EZ defects decreased from 17 (57%) at baseline to 6 (20%) at end of follow-up (p < 0.01). BCVA gain correlated with IZ/EZ defect size reduction (r = 0.41, p = 0.02) but not with improvement in CMT (r = 0.28, p = 0.121). CONCLUSIONS IZ/EZ defect size correlated not only with baseline BCVA but also predicted the change in BCVA after anti-VEGF treatment. Possible future automatic measurement of IZ/EZ defect size might prove helpful for the evaluation of treatment response.
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Affiliation(s)
- Nardine Sharef
- Department of Ophthalmology, Edith Wolfson Medical Center, Holon, Israel and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rabea Kassem
- Department of Ophthalmology, Kaplan Medical Center, Rehovot and the Hebrew University of Jerusalem-Hadassah Medical School, Jerusalem, Israel
| | - Idan Hecht
- Department of Ophthalmology, Shamir Medical Center, Zerifin, Israel and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asaf Bar
- Department of Ophthalmology, Edith Wolfson Medical Center, Holon, Israel and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Idit Maharshak
- Department of Ophthalmology, Edith Wolfson Medical Center, Holon, Israel and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zvia Burgansky-Eliash
- Department of Ophthalmology, Meir Medical Center, Kfar Sava, Israel and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yehonatan Weinberger
- Department of Ophthalmology, Rabin Medical Center, Petah-Tikva, Israel and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raimo Tuuminen
- Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland and Eye Centre, Kymenlaakso Central Hospital, Kotka, Finland
| | - Asaf Achiron
- Department of Ophthalmology, Edith Wolfson Medical Center, Holon, Israel and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel, .,Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom,
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Altinel MG, Kanra AY, Totuk OMG, Ardagil A, Kabadayi K. Comparison of half-dose versus half-fluence versus standard photodynamic therapy in chronic central serous chorioretinopathy. Photodiagnosis Photodyn Ther 2020; 33:102081. [PMID: 33157327 DOI: 10.1016/j.pdpdt.2020.102081] [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] [Received: 08/04/2020] [Revised: 10/19/2020] [Accepted: 10/23/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To compare the efficacy and safety of half-dose vs. half-fluence vs. standard photodynamic therapy (PDT) in patients with chronic central serous chorioretinopathy (cCSC). METHODS This retrospective study included 64 eyes of 61 patients with cCSC who were treated with half-dose PDT (verteporfin 3 mg/m2 and light energy 50 J/cm2), half-fluence PDT (verteporfin 6 mg/m2 and light energy 25 J/cm2) or standard PDT (verteporfin 6 mg/m2 and light energy 50 J/cm2). The complete resorption of subretinal fluid (SRF) and changes of best corrected visual acuity (BCVA) and central retinal thickness (CRT) over the follow-up period were also assessed. RESULTS Fifteen eyes (65.2 %) in the half-dose PDT group, 12 eyes (80 %) in the half-fluence PDT group, and 20 eyes (76.9 %) in the standard PDT group showed complete resolution of SRF. There were no statistically significant differences in the mean BCVA improvement, CRT and SRF height reduction, number of PDT sessions, complete success, and recurrence rates between groups (p > 0.05). None of the eyes with intact EZ showed failure. There were positive correlations between higher mean CRT values of the last visit, 1st, 3rd, 6th months and failure. None of the treated eyes (0%) developed any systemic or local adverse events. CONCLUSION Half-dose, half-fluence or standard PDTs are all effective and safe treatment choices in cCSC with similar BCVA improvements and CRT reductions. The higher mean CRT values of the follow-up period were correlated with failure, and in eyes with intact EZ showed no failure.
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Affiliation(s)
- Meltem Guzin Altinel
- Saglik Bilimleri University Fatih Sultan Mehmet Training and Research Hospital, Ophthalmology Department, 34752, Atasehir, Istanbul, Turkey.
| | | | | | - Aylin Ardagil
- Atakoy Dunyagoz Hospital, 34158, Bakirkoy, Istanbul, Turkey.
| | - Kerem Kabadayi
- Bahcesehir University, Faculty of Medicine, 34734, Kadikoy, Istanbul, Turkey.
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Ha A, Kim YK, Lee J, Bak E, Han YS, Kim YW, Jeoung JW, Park KH. Interdigitation Zone Change According to Glaucoma-Stage Advancement. Invest Ophthalmol Vis Sci 2020; 61:20. [PMID: 32301971 PMCID: PMC7401448 DOI: 10.1167/iovs.61.4.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose To compare the macular interdigitation zone (IZ) of normal eyes with eyes showing different normal-tension glaucoma (NTG) stages. Methods Forty-two normal eyes (age, 56 ± 5.4 years), 45 pre-perimetric eyes (age, 59 ± 6.9 years), 51 mild-to-moderate glaucoma eyes (age, 58 ± 7.2 years; mean deviation [MD], –5.5 ± 3.0 dB), and 50 severe glaucoma eyes (age, 59 ± 6.9 years; MD, –15.1 ± 5.4 dB) were enrolled. All of the subjects underwent high-resolution spectral-domain optical coherence tomography (SD-OCT) to obtain 19 horizontal and 19 vertical macular B-scans 9 mm in length. The en face image of the scan area was divided into 589 rectangular boxes (side length of 375 µm). The IZ locations were marked on the corresponding image boxes. The IZ area was then quantified according to the number of boxes showing IZs among the 589 total boxes. Results The IZ area in the severe glaucoma eyes was significantly smaller than in the mild-to-moderate glaucoma eyes (28.99 ± 7.88 mm2 vs. 40.79 ± 7.46 mm2; P < 0.001), was smaller in the mild-to-moderate glaucoma eyes than in the pre-perimetric glaucoma eyes (40.79 ± 7.46 mm2 vs. 49.92 ± 8.10 mm2; P < 0.001), and was smaller still in the pre-perimetric glaucoma eyes than in the normal eyes (49.92 ± 8.10 mm2 vs. 56.85 ± 7.94 mm2; P < 0.001). In the 146 NTG eyes, a statistically significant correlation was found between IZ area and MD (r = 0.64; P < 0.001). Conclusions SD-OCT revealed a reduction in IZ area in NTG eyes, and the extent of the reduction was positively associated with glaucoma severity. These findings suggest, though tentatively, that changes in the outer retinal layer can occur in the course of glaucoma progression.
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Chatziralli I, Theodossiadis G, Dimitriou E, Kazantzis D, Theodossiadis P. Association between the patterns of diabetic macular edema and photoreceptors' response after intravitreal ranibizumab treatment: a spectral-domain optical coherence tomography study. Int Ophthalmol 2020; 40:2441-2448. [PMID: 32424527 DOI: 10.1007/s10792-020-01423-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/12/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE To analyze photoreceptors' condition after intravitreal ranibizumab treatment according to the pattern of diabetic macular edema (DME) on spectral-domain optical coherence tomography (SD-OCT). METHODS Retrospective study includes 58 treatment naïve patients with DME, treated with intravitreal ranibizumab injections and followed up for at least 12 months. Patients were classified based on DME morphology on SD-OCT into: diffuse macular edema, cystoid macular edema (CME) and serous retinal detachment with CME (SRD/CME). The DME morphology was analyzed, while quantitative measurement of ellipsoid zone (EZ) defect, as well as qualitative assessment of the condition of external limiting membrane (ELM) and interdigitation zone (IZ) at foveal area, was taken before and after treatment. RESULTS Before treatment, patients with CME presented worse ELM and IZ condition and greater EZ defect than patients with diffuse macular edema or SRD/CME. After treatment, the restoration of EZ defect and IZ was more evident in patients with CME than in diffuse macular edema or SRD/CME. CONCLUSION Patients with DME presented significant photoreceptors' restoration after intravitreal ranibizumab injections at the 12-month follow-up. The improvement in EZ defect size and IZ was dependent on the pattern of DME on SD-OCT.
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Affiliation(s)
- Irini Chatziralli
- 2nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece.
- Attikon University Hospital, 1, Rimini Street, 12462, Haidari, Greece.
| | - George Theodossiadis
- 2nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Dimitriou
- 2nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Kazantzis
- 2nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
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Khojasteh H, Riazi-Esfahani H, Khalili Pour E, Faghihi H, Ghassemi F, Bazvand F, Mahmoudzadeh R, Salabati M, Mirghorbani M, Riazi Esfahani M. Multifocal electroretinogram in diabetic macular edema and its correlation with different optical coherence tomography features. Int Ophthalmol 2019; 40:571-581. [PMID: 31712927 DOI: 10.1007/s10792-019-01215-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 10/29/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate multifocal electroretinogram (mfERG) parameters in eyes with diabetic macular edema (DME) and its correlation with vision and optical coherence tomography (OCT) features. METHODS Fifty-four eyes of 27 subjects with DME due to nonproliferative diabetic retinopathy were evaluated. MfERG responses were measured in three concentric rings. Macular thickness was measured by OCT in each segment of the three concentric rings, and mfERG rings were superimposed on the macular thickness map. The correlation between macular thickness in specific points of the thickness map and changes of the mfERG parameters in the corresponding points of the mfERG field map was evaluated and the relationship between the OCT and mfERG changes and changes of best-corrected visual acuity (BCVA) was investigated. The central foveal B-scans of SD-OCT were used to evaluate any correlation between the external limiting membrane (ELM) status, ellipsoid zone (EZ) status, presence of cysts or disorganization of retinal inner layers (DRIL), and mfERG parameters at the central corresponding area. RESULTS The mean of BCVA was 0.5 ± 0.3 in logMAR, and the central macular thickness was 392.6 ± 123.4 microns. The central ring P1 and N2 amplitudes had a significant correlation with BCVA in univariate and multivariate analyses (P = 0.001 for both, r = - 0.346 and r = - 0.646, respectively). There was a significant correlation between retinal thickness and the N1 amplitude in the central ring (P = 0.02, r = - 0.343). Outer retinal layer disruption (ELM and EZ) correlated with prolonged P1 implicit time at the corresponding location (P = 0.005, r = 0.068). The presence of the DRIL was associated with reduced P1 and N2 amplitudes (P = 0.037, r = - 0.284 and P = 0.019, r = - 0.562, respectively). A significant correlation was also found between the presence of cysts and a lower central P1 amplitude (P = 0.033, r = - 0.376). CONCLUSION In diabetic patients, discrete changes of some parameters in the central ring of the mfERG field map (e.g., P1 and N2 amplitudes) have a significant correlation with both structural OCT abnormalities in the corresponding points of the thickness map (like DRIL, intraretinal cyst and ELM/EZ disruption) and BCVA. Predictive models such as those described in this report may make it possible to identify the relationship between specific anatomical and functional characteristics in diabetic retinopathy.
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Affiliation(s)
- Hassan Khojasteh
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, South Kargar Street, Tehran, Iran
| | - Hamid Riazi-Esfahani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, South Kargar Street, Tehran, Iran.
| | - Elias Khalili Pour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, South Kargar Street, Tehran, Iran
| | - Hooshang Faghihi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, South Kargar Street, Tehran, Iran
| | - Fariba Ghassemi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, South Kargar Street, Tehran, Iran
| | - Fatemeh Bazvand
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, South Kargar Street, Tehran, Iran
| | - Raziyeh Mahmoudzadeh
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, South Kargar Street, Tehran, Iran
| | - Mirataollah Salabati
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, South Kargar Street, Tehran, Iran
| | - Masoud Mirghorbani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, South Kargar Street, Tehran, Iran
| | - Mohammad Riazi Esfahani
- Department of Ophthalmology, Gavin Herbert Eye Institute, University of California Irvine, Irvine, CA, USA
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Hsieh YT, Alam MN, Le D, Hsiao CC, Yang CH, Chao DL, Yao X. OCT Angiography Biomarkers for Predicting Visual Outcomes after Ranibizumab Treatment for Diabetic Macular Edema. Ophthalmol Retina 2019; 3:826-834. [PMID: 31227330 PMCID: PMC6921516 DOI: 10.1016/j.oret.2019.04.027] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 04/05/2019] [Accepted: 04/26/2019] [Indexed: 04/12/2023]
Abstract
PURPOSE To correlate quantitative OCT angiography (OCTA) biomarkers with clinical features and to predict the extent of visual improvement after ranibizumab treatment for diabetic macular edema (DME) with OCTA biomarkers. DESIGN Retrospective, longitudinal study in Taiwan. PARTICIPANTS Fifty eyes of 50 patients with DME and 22 eyes of 22 healthy persons, with the exception of cataract and refractive error, from 1 hospital. METHODS Each eye underwent OCT angiography (RTVue XR Avanti System with AngioVue software version 2017.1; Optovue, Fremont, CA), and 3×3-mm2 en face OCTA images of the superficial layer and the deep layer were obtained at baseline and after 3 monthly injections of ranibizumab in the study group. OCT angiography images also were acquired from the control group. MAIN OUTCOME MEASURES Five OCTA biomarkers, including foveal avascular zone (FAZ) area (FAZ-A), FAZ contour irregularity (FAZ-CI), average vessel caliber (AVC), vessel tortuosity (VT), and vessel density (VD), were analyzed comprehensively. Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) also were obtained. Student t tests were used to compare the OCTA biomarkers between the study group and the control group. Linear regression models were used to evaluate the correlations between the baseline OCTA biomarkers and the changes of BCVA and CRT after treatment. RESULTS Eyes with DME had larger AVC, VT, FAZ-A, and FAZ-CI and lower VD than those in the control group (P < 0.001 for all). After the loading ranibizumab treatment, these OCTA biomarkers improved but did not return to normal levels. Among all biomarkers, higher inner parafoveal VD in the superficial layer at baseline correlated most significantly with visual gain after treatment in the multiple regression model with adjustment for CRT and ellipsoid zone disruption (P < 0.001). To predict visual improvement, outer parafoveal VD in the superficial layer at the baseline showed the largest area under the receiver operating characteristic curve (0.787; P = 0.004). No baseline OCTA biomarkers showed any significant correlation specifically with anatomic improvement. CONCLUSIONS For eyes with DME, parafoveal VD in the superficial layer at baseline was an independent predictor for visual improvement after the loading ranibizumab treatment.
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Affiliation(s)
- Yi-Ting Hsieh
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan.
| | - Minhaj Nur Alam
- Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois
| | - David Le
- Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois
| | - Chia-Chieh Hsiao
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chang-Hao Yang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan; School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Daniel L Chao
- Shiley Eye Institute, Department of Ophthalmology, University of California San Diego, San Diego, California
| | - Xincheng Yao
- Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois
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Roy R, Saurabh K, Shah D, Chowdhury M, Goel S. Choroidal Hyperreflective Foci: A Novel Spectral Domain Optical Coherence Tomography Biomarker in Eyes With Diabetic Macular Edema. Asia Pac J Ophthalmol (Phila) 2019; 8:314-318. [PMID: 31397675 PMCID: PMC6727920 DOI: 10.1097/apo.0000000000000249] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 04/01/2019] [Indexed: 01/14/2023] Open
Abstract
PURPOSE The aim of this study was to examine the hyperreflective dots seen in choroid on spectral domain optical coherence tomography (SDOCT) in eyes with diabetic macular edema (DME) and correlate it with visual acuity. DESIGN Consecutive, cross-sectional case series of patients with DME between January 2017 and December 2017. METHODS Eyes with DME having central foveal thickness ≥250 μm were included. SDOCT was performed using Spectralis system (Heidelberg Engineering, Germany). Hyperreflective choroidal foci (HCF) were defined as well-circumscribed dots within choroid having reflectivity equal to or higher than adjacent retinal pigment epithelium. HCF were counted manually within 1500 μm of fovea using a horizontal line scan by a blinded observer. Eyes were divided in 3 groups: group A (no HCF), group B (1-10 HCF), and group C (>10 HCF). RESULTS One hundred nineteen eyes of 60 DME patients were included. Sixty (50.4%) eyes were in group A, whereas 42 (33.6%) and 17 (14.2%) eyes belonged to group B and group C, respectively. The mean logMAR best corrected visual acuity was significantly lower in group B (0.76 ± 0.79) and C (1.2 ± 0.78) as compared with group A (0.22 ± 0.49) (P = 0.001). Mean central foveal thickness in group A (300.4 ± 122.4 μm) was significantly lower than group B (455.52 ± 209.1 μm) and group C (529.4 ± 196.4 μm) with P value of 0.001. CONCLUSIONS The present study describes HCF as novel prognostic SDOCT biomarker in DME whose presence denotes poor visual acuity. Further longitudinal studies are required to substantiate our findings.
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Affiliation(s)
- Rupak Roy
- Retina Services, Aditya Birla Sankara Nethralaya, Mukundapur, Kolkata, West Bengal, India
| | - Kumar Saurabh
- Retina Services, Kamalnayan Bajaj Sankara Nethralaya, New Town, Kolkata, West Bengal, India
| | - Dhaivat Shah
- Retina Services, Aditya Birla Sankara Nethralaya, Mukundapur, Kolkata, West Bengal, India
| | - Maitreyi Chowdhury
- Retina Services, Aditya Birla Sankara Nethralaya, Mukundapur, Kolkata, West Bengal, India
| | - Sugandha Goel
- Retina Services, Aditya Birla Sankara Nethralaya, Mukundapur, Kolkata, West Bengal, India
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Achiron A, Kydyrbaeva A, Man V, Lagstein O, Burgansky Z, Blumenfeld O, Bar A, Bartov E. Photoreceptor Integrity Predicts Response to Anti-VEGF Treatment. Ophthalmic Res 2016; 57:37-41. [PMID: 27627204 DOI: 10.1159/000448522] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 07/15/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE Assessing changes in foveal photoreceptor microstructure (FPM) following intravitreal anti-VEGF treatment may serve as a prognostic marker in patients with macular edema (ME). METHODS Sixteen eyes belonging to newly diagnosed patients with ME were included in this prospective longitudinal study. FPM integrity was evaluated at baseline and at the end of a series of anti-VEGF injections. RESULTS Treatment led to a significant improvement in mean visual acuity (VA) and central macular thickness. A larger FPM defect was associated with lower VA, both before and after treatment. Patients with larger FPM defects at baseline had smaller VA improvements, and the improvement in FPM integrity was associated with VA improvement (every 100-µm FPM recovery contributed to a gain of 0.04 logMAR). CONCLUSIONS Recovery of FPM after anti-VEGF treatment was significantly associated with a VA improvement. Direct measurement of photoreceptor integrity might provide an additional tool for the assessment of retinal function and treatment response in patients newly diagnosed with ME.
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Affiliation(s)
- Asaf Achiron
- Department of Ophthalmology, Edith Wolfson Medical Center, Holon, Israel
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