1
|
Iovino C, Iodice CM, Pisani D, Damiano L, Di Iorio V, Testa F, Simonelli F. Clinical Applications of Optical Coherence Tomography Angiography in Inherited Retinal Diseases: An Up-to-Date Review of the Literature. J Clin Med 2023; 12:jcm12093170. [PMID: 37176614 PMCID: PMC10179546 DOI: 10.3390/jcm12093170] [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: 03/21/2023] [Revised: 04/14/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
Optical coherence tomography angiography (OCT-A) is a valuable imaging technique, allowing non-invasive, depth-resolved, motion-contrast, high-resolution images of both retinal and choroidal vascular networks. The imaging capabilities of OCT-A have enhanced our understanding of the retinal and choroidal alterations that occur in inherited retinal diseases (IRDs), a group of clinically and genetically heterogeneous disorders that may be complicated by several vascular conditions requiring a prompt diagnosis. In this review, we aimed to comprehensively summarize all clinical applications of OCT-A in the diagnosis and management of IRDs, highlighting significant vascular findings on retinitis pigmentosa, Stargardt disease, choroideremia, Best disease and other less common forms of retinal dystrophies. All advantages and limitations of this novel imaging modality will be also discussed.
Collapse
Affiliation(s)
- Claudio Iovino
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Clemente Maria Iodice
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Danila Pisani
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Luciana Damiano
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Valentina Di Iorio
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Francesco Testa
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Francesca Simonelli
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| |
Collapse
|
2
|
Diaconita V, Kassotis A, Ngo WK. Optical Coherence Tomography Angiography (OCTA) Findings in Retinitis Pigmentosa. Methods Mol Biol 2022; 2560:101-109. [PMID: 36481887 DOI: 10.1007/978-1-0716-2651-1_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Optical coherence tomography angiography (OCTA) is a noninvasive new imaging modality that can be used to diagnose and monitor progression of retinitis pigmentosa (RP). Cohorts and case series have shown correlation between OCTA findings and visual function and disease severity. Although an early use of the technology is promising, there are concerns about segmentation errors and artifacts. There is also a paucity of data on genotype and how that correlates with OCTA findings. Despite its limitations, OCTA remains a useful tool for clinicians managing retinitis pigmentosa patients.
Collapse
Affiliation(s)
- Vlad Diaconita
- Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University, New York, NY, USA.
| | - Alexis Kassotis
- Ophthalmology Resident, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, USA
| | - Wei Kiong Ngo
- Departments of Ophthalmology, Pathology & Cell Biology, Graduate Programs in Nutritional & Metabolic Biology and Neurobiology & Behavior, Columbia Stem Cell Initiative, New York, NY, USA
| |
Collapse
|
3
|
D’Aloisio R, Di Antonio L, Toto L, Rispoli M, Di Iorio A, Delvecchio G, Mastropasqua R. Choroidal Changes in Blood Flow in Patients with Intermediate AMD after Oral Dietary Supplement Based on Astaxanthin, Bromelain, Vitamin D3, Folic Acid, Lutein, and Antioxidants. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58081092. [PMID: 36013559 PMCID: PMC9412262 DOI: 10.3390/medicina58081092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/04/2022] [Accepted: 08/09/2022] [Indexed: 11/18/2022]
Abstract
Background and Objectives: The aim of this study was to investigate the impact of oral administration of the combination of astaxanthin (AXT), lutein, folic acid, vitamin D3, and bromelain with antioxidants on choroidal blood flow in patients with age-related intermediate macular degeneration (AMD). Materials and Methods: Patients affected by intermediate AMD and treated with daily oral nutritional supplement with AXT, bromelain, vitamin D3, folic acid, lutein, and antioxidants for a period of at least 6 months were included in this retrospective study. A control group homogenous for age and sex was also included in the analysis. All participants underwent a complete ophthalmologic examination, spectral domain optical coherence tomography (SD-OCT), and optical coherence tomography angiography (OCTA) evaluation. Outcome measures were choroidal thickness (CHT) and choriocapillary vessel density (CCVD) after six months of AXT assumption. Results: CCVD values showed statistically significant difference between cases and controls at baseline (p < 0.001) and in the cases during follow-up (p < 0.001). The CHT measurements showed statistically significant difference between cases and controls (p = 0.002) and in the cases during follow-up (p < 0.001). Conclusions: The combined use of structural OCT and OCTA allows for a detailed analysis in vivo of perfusion parameters of the choriocapillaris and choroid and evaluation of changes of choroidal blood flow after oral nutritional supplements that affect blood flow velocity.
Collapse
Affiliation(s)
- Rossella D’Aloisio
- Department of Medicine and Science of Ageing, Ophthalmology Clinic, Chieti-Pescara, 66100 Chieti, Italy
- Correspondence:
| | - Luca Di Antonio
- Department of Medicine and Science of Ageing, Ophthalmology Clinic, Chieti-Pescara, 66100 Chieti, Italy
| | - Lisa Toto
- Department of Medicine and Science of Ageing, Ophthalmology Clinic, Chieti-Pescara, 66100 Chieti, Italy
| | - Marco Rispoli
- Ophthalmology Department UOSD Medical Retina, Eye Hospital, 00193 Rome, Italy
| | - Angelo Di Iorio
- Department of Innovative Technologies in Medicine & Dentistry, University “G. d’Annunzio”; Chieti-Pescara, 66100 Chieti, Italy
| | - Giancarlo Delvecchio
- Department of Ophthalmology, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Rodolfo Mastropasqua
- Department of Ophthalmology, University of Modena and Reggio Emilia, 41121 Modena, Italy
| |
Collapse
|
4
|
Giansanti F, Vicini G, Sodi A, Nicolosi C, Bellari L, Virgili G, Rizzo S, Bacherini D. Optical Coherence Tomography Angiography for the Evaluation of Retinal and Choroidal Vasculature in Retinitis Pigmentosa: A Monocentric Experience. Diagnostics (Basel) 2022; 12:1020. [PMID: 35626176 PMCID: PMC9139633 DOI: 10.3390/diagnostics12051020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/03/2022] [Accepted: 04/16/2022] [Indexed: 02/04/2023] Open
Abstract
Purpose: We investigated the chorioretinal microvascular changes in patients with retinitis pigmentosa (RP) by optical coherence tomography angiography (OCTA). Methods: Twenty-six patients (52 eyes) affected by RP were compared with 19 healthy controls (38 eyes). OCTA 3 mm × 3 mm macular scans were performed in all subjects. We evaluated the vessel density (VD) of the superficial capillary plexus (VD SCP), deep capillary plexus (VD DCP), choriocapillaris (VD CC), and choroid (VD choroid). We also evaluated the foveal avascular zone (FAZ) area, and the correlation between clinical and OCTA parameters. We also measured central retinal thickness (CRT) and subfoveal choroidal thickness (CT). Results: RP patients compared to healthy controls showed significantly lower VD SCP values (27.56% ± 15.37 vs. 49.39% ± 1.55; p-value < 0.0001), lower VD DCP values (38.43% ± 15.23 vs. 3.34% ± 0.26; p-value < 0.0001), lower VD CC values (46.02% ± 1.293 vs. 50.63% ± 0.4274; p-value = 0.0040), and lower VD choroid values (38.48% ± 15.23 vs. 3.34% ± 0.26; p-value < 0.0001). Even the FAZ area was significantly lower in RP patients (0.45 mm2 ± 0.35 vs. 0.26 mm2 ± 0.13; p-value < 0.0001). The FAZ area was larger with increasing age, both in control (r = 0.42; p = 0.012) and RP group (r = 0.46; p-value = 0.009). In RP patients, there was a statistically significant correlation between best-corrected visual acuity and VD SCP (r = 0.24, p-value = 0.04) and VD DCP (r = 0.52; p-value = 0.0004) and between subfoveal choroidal thickness and VD SCP (r = 0.43, p-value < 0.001) and VD DCP (r = 0.35, p-value < 0.001). Conclusions: In our study, OCTA reported relevant vascular alterations in RP patients in comparison with the healthy controls, in agreement with the published literature. These abnormalities were associated with choroidal atrophy and related to visual acuity loss. OCTA provided clinically significant information and may represent a reliable tool for the management of RP patients.
Collapse
Affiliation(s)
- Fabrizio Giansanti
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy; (F.G.); (A.S.); (C.N.); (G.V.); (D.B.)
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50139 Florence, Italy;
| | - Giulio Vicini
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy; (F.G.); (A.S.); (C.N.); (G.V.); (D.B.)
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50139 Florence, Italy;
| | - Andrea Sodi
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy; (F.G.); (A.S.); (C.N.); (G.V.); (D.B.)
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50139 Florence, Italy;
| | - Cristina Nicolosi
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy; (F.G.); (A.S.); (C.N.); (G.V.); (D.B.)
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50139 Florence, Italy;
| | - Lavinia Bellari
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50139 Florence, Italy;
| | - Gianni Virgili
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy; (F.G.); (A.S.); (C.N.); (G.V.); (D.B.)
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50139 Florence, Italy;
| | - Stanislao Rizzo
- Ophthalmology Unit, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli, 00168 Rome, Italy;
- Consiglio Nazionale delle Ricerche (CNR), 56124 Pisa, Italy
| | - Daniela Bacherini
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy; (F.G.); (A.S.); (C.N.); (G.V.); (D.B.)
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50139 Florence, Italy;
| |
Collapse
|
5
|
Monferrer-Adsuara C, Montero-Hernández J, Castro-Navarro V, Remolí-Sargues L, Cervera-Taulet E. Case Report: Multimodal Imaging Features of an ABCA4 Cone Dystrophy. Optom Vis Sci 2022; 99:195-201. [PMID: 34897229 DOI: 10.1097/opx.0000000000001849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SIGNIFICANCE Cone dystrophies and cone-rod dystrophies are a group of rare inherited pathologies characterized by degeneration of cone photoreceptors and subsequent rod involvement. The identification of causative genes is essential for diagnosis, and advanced imaging is acquiring great value in the characterization of the different phenotypic expressions. PURPOSE We describe genotype-phenotype associations of an autosomal recessive ABCA4-associated cone dystrophy using multimodal imaging. CASE REPORT A 34-year-old woman presented with progressive visual acuity decay. Visual acuity was 20/32 for her right eye and 20/25 for her left eye. A central scotoma was detected on a 10-2 Humphrey visual field in both eyes. Funduscopy revealed perifoveal retinal pigment epithelial changes, and fundus autofluorescence using blue excitation light showed decreased autofluorescence in the central fovea of both eyes with surrounding annular ring of increased autofluorescence in the perifoveal zone; green excitation light fundus autofluorescence was more accurate in the characterization of the size, perimeter, and circularity of central hypofluorescent lesions. Optical coherence tomography revealed an incomplete focal cavitation in both foveas, and optical coherence tomography angiography images showed a reduction in the superficial and deep capillary plexus density, an increased foveal avascular area, and subtle voids in choriocapillaris blood flow. Electroretinography was consistent with cone dystrophy, and molecular testing revealed the alteration of the ABCA4 gene. CONCLUSIONS The identification of an incomplete focal cavitation could alert the clinician to consider early ABCA4 central cone dystrophy. The patient in this case also exhibited reduced vessel density in the foveal area. Both of these characteristics could be important features related to the underlying genetic mutation.
Collapse
Affiliation(s)
| | | | | | - Lidia Remolí-Sargues
- Department of Ophthalmology, Hospital General Universitario de Valencia, Valencia, Spain
| | | |
Collapse
|
6
|
Deutsch S, Lommatzsch A, Weinitz S, Farmand G, Kellner U. Optical coherence tomography angiography (OCT-A) in retinitis pigmentosa and macular dystrophy patients: a retrospective study. Graefes Arch Clin Exp Ophthalmol 2022; 260:1923-1931. [PMID: 34982219 PMCID: PMC9061664 DOI: 10.1007/s00417-021-05530-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 12/10/2021] [Accepted: 12/16/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose To evaluate macular vascular abnormalities in patients with macular dystrophies (MD) and retinitis pigmentosa (RP) through application of optical coherence tomography angiography (OCT-A). Methods In this retrospective study, patients with MD and RP were examined by OCT-A and compared to healthy individuals. OCT-A images were analyzed regarding the diameter and surface area of the foveal avascular zone (FAZ) as well as flow (FL) in different retinal layers (superficial vascular complex (SVC), intermediate capillary complex (ICP), deep capillary complex (DCP), choriocapillaris (CC), and choroid (CD)). Results Twenty-one patients with MD, 21 patients with RP without macular edema (RPnE), 8 patients with RP with edema (RPwE), and 41 healthy individuals were enrolled. The group of MD and RPnE patients showed none or only minor changes in FAZ. In RPwE patients, the FAZ was significantly smaller in vertical and horizontal measurements and surface area in SVC, whereas it was markedly enlarged in ICP. FL was significantly reduced compared to healthy individuals by an average of 13.2% in CD, 14.2% in CC, and 8.4% in DCP in all patient groups. In ICP, the reduction was 9.2% for RPnE and 12.7% for RPwE patients. The SVC showed reduced FL in the MD (8.1%) and RPnE (10.3%) group. Conclusions OCT-A is a valuable tool to examine retinal vascular abnormalities in patients with MD and RP. OCT-A revealed a reduced flow in various retinal layers in MD, RPnE, and RPwE. Alterations of the FAZ were less distinct in these groups which add to the variation reported previously.
Collapse
Affiliation(s)
- Sebastian Deutsch
- Rare Retinal Disease Center, AugenZentrum Siegburg, MVZ Augenärztliches Diagnostik- Und Therapiezentrum Siegburg GmbH, Siegburg, Germany. .,Department of Ophthalmology, University Hospital Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany.
| | - Albrecht Lommatzsch
- Eye Care Center at St. Franziskus Hospital Münster, Münster, Germany.,Achim-Wessing-Institute for Ophthalmologic Diagnostics, University Hospital Essen, Essen, Germany
| | - Silke Weinitz
- Rare Retinal Disease Center, AugenZentrum Siegburg, MVZ Augenärztliches Diagnostik- Und Therapiezentrum Siegburg GmbH, Siegburg, Germany.,RetinaScience, Bonn, Germany
| | - Ghazaleh Farmand
- Rare Retinal Disease Center, AugenZentrum Siegburg, MVZ Augenärztliches Diagnostik- Und Therapiezentrum Siegburg GmbH, Siegburg, Germany
| | - Ulrich Kellner
- Rare Retinal Disease Center, AugenZentrum Siegburg, MVZ Augenärztliches Diagnostik- Und Therapiezentrum Siegburg GmbH, Siegburg, Germany.,RetinaScience, Bonn, Germany
| |
Collapse
|
7
|
Ong SS, Liu TYA, Li X, Singh MS. Choriocapillaris flow loss in center-involving retinitis pigmentosa: a quantitative optical coherence tomography angiography study using a novel classification system. Graefes Arch Clin Exp Ophthalmol 2021; 259:3235-3242. [PMID: 34057549 PMCID: PMC11234870 DOI: 10.1007/s00417-021-05223-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 04/02/2021] [Accepted: 04/27/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE Choriocapillaris insufficiency may play a role in centripetal retinitis pigmentosa (RP) progression involving the fovea. However, the relationship between choriocapillaris integrity and foveal damage in RP is unclear. We examined the relationship between choriocapillaris flow and the presence of foveal photoreceptor involvement in RP. METHODS We categorized the severity of central involvement in RP by the occurrence of foveal ellipsoid zone (EZ) disruption: present (severe RP) or absent (mild RP). Using optical coherence tomography angiography (OCTA, AngioVue, Optovue) in cases and unaffected age-matched controls, we compared vessel density (VD) between the groups using the generalized linear mixed model, controlling for age, gender, and scan quality. RESULTS Fifty-seven eyes (20 severe RP, 18 mild RP, and 19 controls) were included. Foveal and parafoveal mean outer retinal thickness (µm) were lower in severe RP (fovea: 101.3 ± 14.5; parafovea: 68.4 ± 11.7) than controls (fovea: 161.2 ± 8.9; parafovea: 142.1 ± 11.8; p ≤ 0.001) and mild RP (fovea: 162.0 ± 14.7; parafovea: 116.8 ± 29.4; p ≤ 0.0001). Foveal choriocapillaris VD (%) was lower in severe RP (56.7 ± 6.8) than controls (69.9 ± 4.6; p = 0.008) and mild RP (65.3 ± 5.3; p = 0.01). The parafoveal choriocapillaris VD was lower in severe RP than controls (64.4 ± 5.9 vs. 68.3 ± 4.1; p = 0.04) but no different than in mild RP (p = 0.4). CONCLUSION Choriocapillaris flow loss was associated with fovea-involving photoreceptor damage in RP. Further research is warranted to validate this putative association and clarify causation. Choriocapillaris imaging using OCTA may provide information to supplement structural OCT findings when evaluating subjects with RP in neuroprotective or regenerative clinical trials.
Collapse
Affiliation(s)
- Sally S Ong
- Wilmer Eye Institute, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 600 N Wolfe St, Baltimore, MD, 21287, USA
- Department of Ophthalmology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - T Y Alvin Liu
- Wilmer Eye Institute, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 600 N Wolfe St, Baltimore, MD, 21287, USA
| | - Ximin Li
- Department of Biostatistics, Wilmer Biostatistics Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mandeep S Singh
- Wilmer Eye Institute, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 600 N Wolfe St, Baltimore, MD, 21287, USA.
| |
Collapse
|
8
|
Early Vascular and Functional Changes after Vitreoretinal Surgery: A Comparison between the Macular Hole and Epiretinal Membrane. Diagnostics (Basel) 2021; 11:diagnostics11061031. [PMID: 34205224 PMCID: PMC8226563 DOI: 10.3390/diagnostics11061031] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/28/2021] [Accepted: 05/31/2021] [Indexed: 01/01/2023] Open
Abstract
(1) Background: The aim of this observational comparative study was to investigate early retinal vascular and functional changes in patients undergoing vitreoretinal surgery for idiopathic epiretinal membrane (iERM) or macular hole (MH) using a widefield swept-source optical coherence tomography angiography (WSS-OCTA). (2) Methods: Forty one diseased eyes were enrolled in the study. Twenty three eyes with iERM diagnosis (ERM group) underwent 25-gauge vitrectomy with inner limiting membrane (ILM) and MER peeling, while eighteen eyes with MH (MH group) underwent 25-gauge vitrectomy with inverted flap technique. Functional and anatomical/perfusion parameters were evaluated pre- and postoperatively in all eyes by means of WSS-OCTA system, microperimetry (MP3), best corrected visual acuity assessment, central macular thickness (CMT) and MH diameter calculation. For each eye, 12 × 12 mm OCTA volume scans were acquired by a retinal specialist and a semi-automated algorithm was used for a quantitative vessel analysis of the superficial capillary plexus (SCP), deep capillary plexus (DCP) and choriocapillaris (CC). In detail, perfusion density (PD) of the SCP, DCP and CC was evaluated in four circles (one central in the macular area of 5 mm diameter; three midperiphery circles (temporal, superior and inferior) of 3 mm). In addition, the vessel length density (VLD) of the SCP and DCP for the same circles was quantified. (3) Results: In the MH group, PD of the SCP significantly increased in the macular area (p = 0.018) and in the superior ring (p = 0.016); PD of the DCP significantly increased in the macular area (p = 0.015) and in the superior and inferior ring (p = 0.016) 3 months after surgery. In the ERM group, PD of the SCP and DCP significantly increased in the macular area and superior ring, respectively (p = 0.001; p = 0.032), 3 months after surgery. During follow-up there was a significant improvement in terms of functional (Best corrected visual acuity, p = 0.007 and p = 0.029; microperimetry ((MP3) 10°, p = 0.003 and p = 0.004; MP3 2°, p = 0.028 and p = 0.003 in MH group and ERM group respectively) and anatomical parameters (CMT, p = 0.049 in ERM group; hole complete closure in MH group). (4) Conclusions: After vitreoretinal surgery, early retinal vascular and functional changes can be promptly observed and quantified to monitor and potentially predict surgery outcomes. Widefield OCTA devices allow for a detailed microvasculature analysis of retina and choriocapillaris in the macular area and in the periphery, showing a different behaviour of retinal sectors in two distinct vitreoretinal disorders.
Collapse
|
9
|
Albertos-Arranz H, Sánchez-Sáez X, Martínez-Gil N, Pinilla I, Coco-Martin RM, Delgado J, Cuenca N. Phenotypic Differences in a PRPH2 Mutation in Members of the Same Family Assessed with OCT and OCTA. Diagnostics (Basel) 2021; 11:diagnostics11050777. [PMID: 33925984 PMCID: PMC8146155 DOI: 10.3390/diagnostics11050777] [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] [Received: 03/29/2021] [Revised: 04/15/2021] [Accepted: 04/23/2021] [Indexed: 11/16/2022] Open
Abstract
Choroidal dystrophies comprise a group of chorioretinal degenerations. However, the different findings observed among these patients make it difficult to establish a correct clinical diagnosis. The objective of this study was to characterize new clinical findings by optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) in these patients. Four family members with a PRPH2 gene mutation (p.Arg195Leu) were included. OCT was performed at the macula, and the thickness of the outer and inner retina, total retina, and choroid was measured. The features of the vascular network were analyzed by OCTA. Patients showed a decreased outer nuclear layer in the avascular area compared with the controls. Two patients presented greater foveal and parafoveal degeneration of the outer retina, whereas the most degenerated area in the rest was the perifovea. Disruption of the third outer band at the foveola is one of the first-altered outer bands. Slow blood flow areas or capillary dropout were main signs in the deep capillary plexus. Microaneurysms were frequently observed in less degenerated retinas. Vascular loops and intraretinal microvascular abnormalities (IRMAs) were present in the superficial plexus. Extensive degeneration of the choriocapillaris was detected. Phenotypic differences were found between patients: two showed central areolar choroidal dystrophy and the rest had extensive chorioretinal atrophy. These signs observed in OCT and OCTA can help to more appropriately define the clinical disease in patients with choroidal dystrophies.
Collapse
Affiliation(s)
- Henar Albertos-Arranz
- Department of Physiology, Genetics and Microbiology, University of Alicante, 03690 Alicante, Spain; (H.A.-A.); (X.S.-S.); (N.M.-G.)
| | - Xavier Sánchez-Sáez
- Department of Physiology, Genetics and Microbiology, University of Alicante, 03690 Alicante, Spain; (H.A.-A.); (X.S.-S.); (N.M.-G.)
| | - Natalia Martínez-Gil
- Department of Physiology, Genetics and Microbiology, University of Alicante, 03690 Alicante, Spain; (H.A.-A.); (X.S.-S.); (N.M.-G.)
| | - Isabel Pinilla
- Department of Ophthalmology, Aragon Health Science Institute (IIS Aragón), Lozano Blesa University Hospital, 50009 Zaragoza, Spain;
- National Institute of Health Carlos III (ISCIII), (RETICS) Cooperative Health Network for Research in Ophthalmology (Oftared), 28040 Madrid, Spain;
| | - Rosa M. Coco-Martin
- National Institute of Health Carlos III (ISCIII), (RETICS) Cooperative Health Network for Research in Ophthalmology (Oftared), 28040 Madrid, Spain;
- Institute of Applied Ophthalmobiology (IOBA), Medical School, University of Valladolid, 47011 Valladolid, Spain
| | | | - Nicolás Cuenca
- Department of Physiology, Genetics and Microbiology, University of Alicante, 03690 Alicante, Spain; (H.A.-A.); (X.S.-S.); (N.M.-G.)
- National Institute of Health Carlos III (ISCIII), (RETICS) Cooperative Health Network for Research in Ophthalmology (Oftared), 28040 Madrid, Spain;
- San Vicente del Raspeig Campus, Ramón Margalef Institute, University of Alicante, 03690 Alicante, Spain
- Correspondence: ; Tel.: +34-965-909-916
| |
Collapse
|
10
|
Huang J, Li Y, Chen Y, You Y, Niu T, Zou W, Luo W. Multifocal Electroretinogram Can Detect the Abnormal Retinal Change in Early Stage of type2 DM Patients without Apparent Diabetic Retinopathy. J Diabetes Res 2021; 2021:6644691. [PMID: 33681384 PMCID: PMC7925060 DOI: 10.1155/2021/6644691] [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: 12/29/2020] [Revised: 02/06/2021] [Accepted: 02/12/2021] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To study retinal function defects in type 2 diabetic patients without clinically apparent retinopathy using a multifocal electroretinogram (mf-ERG). METHODS Seventy-six eyes of thirty-eight type 2 diabetes mellitus(DM) patients without clinically apparent retinopathy and sixty-four normal eyes of thirty-two healthy control (HC) participants were examined using mf-ERG. RESULTS Patients with type 2 DM without apparent diabetic retinopathy demonstrated an obvious implicit time delay of P1 in ring 1, ring 3, and ring 5 compared with healthy controls (t = 5.184, p ≤ 0.001; t = 8.077, p ≤ 0.001; t = 2.000, p = 0.047, respectively). The implicit time (IT) in ring 4 of N1wave was significantly delayed in the DM group (t = 2.327, p = 0.021). Compared with the HC group, the implicit time of the P1 and N1 waves in the temporal retina zone was significantly prolonged (t = 3.66, p ≤ 0.001; t = 2.187, p = 0.03, respectively). And the amplitude of P1 in the temporal retina decreased in the DM group, which had a significantly statistical difference with the healthy controls (t = -6.963, p ≤ 0.001). However, there were no differences in either the amplitude of the response or the implicit time of the nasal retina zone between DM and HC. The AUC of multiparameters of mf-ERG was higher in the diagnosis of DR patients. CONCLUSIONS Patients with type 2 DM without clinically apparent retinopathy had a delayed implicit time of P1 wave in temporal regions of the postpole of the retina compared with HC subjects. It demonstrates that mf-ERG can detect the abnormal retinal change in the early stage of type2 DM patients without apparent diabetic retinopathy. Multiparameters of mf-ERG can improve the diagnostic efficacy of DR, and it may be a potential clinical biomarker for early diagnosis of DR.
Collapse
Affiliation(s)
- Jiang Huang
- Department of Ophthalmology, Second Affiliated Hospital of Soochow University, China
| | - Yi Li
- Department of Ophthalmology, Huashan Hospital North, Fudan University, China
| | - Yao Chen
- Department of Ophthalmology, Second Affiliated Hospital of Soochow University, China
| | - Yuhong You
- Department of Ophthalmology, Second Affiliated Hospital of Soochow University, China
| | - Tongtong Niu
- Department of Ophthalmology, Second Affiliated Hospital of Soochow University, China
| | - Weijie Zou
- Department of Ophthalmology, Second Affiliated Hospital of Soochow University, China
| | - Weifeng Luo
- Department of Neurology, Second Affiliated Hospital of Soochow University, China
| |
Collapse
|
11
|
Zabek O, Camenzind Zuche H, Müller U, Scholl HPN, Rickmann A, Della Volpe Waizel M. Optical coherence tomography angiography findings in patients undergoing transcorneal electrical stimulation for treating retinitis pigmentosa. Graefes Arch Clin Exp Ophthalmol 2020; 259:1167-1177. [PMID: 33037922 PMCID: PMC8102288 DOI: 10.1007/s00417-020-04963-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 09/01/2020] [Accepted: 10/02/2020] [Indexed: 12/02/2022] Open
Abstract
Purpose Transcorneal electrical stimulation (TES) is a novel treatment approach for patients with retinitis pigmentosa (RP). The aim of our study was to observe changes in optical coherence tomography angiography (OCTA) that would be attributed to TES treatment. Methods A total of 73 eyes were included: 43 eyes of 22 subjects (11 ♀, 11 ♂) suffering from RP were examined at baseline (BL), after first stimulation (TS), 1 week (1W), and 6 months (6M) after treatment initiation and were compared with 30 control eyes of 15 subjects (8 ♀, 7 ♂). TES was performed simultaneously on both eyes for 30 min weekly. OCTA scans of 9 × 15 mm were recorded with a PLEX Elite 9000 swept-source OCTA device (Carl Zeiss Meditec AG, Jena). Vascular density metrics such as perfusion density (PD) and vessel density (VD) were calculated automatically for the macular area by using standardised extended early treatment diabetic retinopathy study (ETDRS) grids centred around the fovea. In addition, the capillary perfusion density (CPD) and the capillary flux index (CFI) of the peripapillary nerve fibre layer microvasculature in all four quadrants of an annulus centred at the optic disc were measured. All parameters were determined over all retinal layers and separately for the superficial (SCP) and deep capillary plexus (DCP). ANOVA-based linear mixed-effects models were calculated with SPSS®. Results Throughout the course of TES treatment, the macular VD and PD of all retinal layers in all subsections showed a slight decrement without reaching statistical significance, also when analysed separately in the SCP and DCP (p > 0.08). In analogy, the average CPD and CFI also presented with a slight decrement (p > 0.20). However, when compared with controls, most OCTA parameters showed a significant decrement (p < 0.05). When analysed systematically in all subsections of the extended ETDRS grid, the temporal macular subsections within the outer ring (radius 1.5–3 mm) and also of the peripheral C1, C2, and C3 rings (radius 3–7.5 mm) showed lower VD and PD values when compared with the other subsections (p < 0.05). Conclusion Vascular density metrics in the macular region and the peripapillary microvasculature appear to remain unaffected by continuous TES treatment within a period of 6 months. Electronic supplementary material The online version of this article (10.1007/s00417-020-04963-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Olga Zabek
- Department of Ophthalmology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Hanna Camenzind Zuche
- Department of Ophthalmology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Ursula Müller
- Department of Ophthalmology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Hendrik P N Scholl
- Department of Ophthalmology, University Hospital Basel, University of Basel, Basel, Switzerland
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland
| | | | - Maria Della Volpe Waizel
- Department of Ophthalmology, University Hospital Basel, University of Basel, Basel, Switzerland.
- Eye Clinic, Knappschaft Hospital Sulzbach, Sulzbach, Saar, Germany.
| |
Collapse
|
12
|
Cone Dystrophies: An Optical Coherence Tomography Angiography Study. J Clin Med 2020; 9:jcm9051500. [PMID: 32429449 PMCID: PMC7291061 DOI: 10.3390/jcm9051500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 11/17/2022] Open
Abstract
Background: This study investigates the relationship between retinal vascularization and macular function in patients with cone dystrophies (CDs). Methods: Twenty CD patients (40 eyes) and 20 healthy controls (20 eyes) were enrolled in this prospective case-control study. Patients underwent full ophthalmological examination, microperimetry, full-field, pattern and multifocal electroretinogram (ERG, PERG, mfERG) and optical coherence tomography angiography (OCTA). Main outcome measures were as follows: foveal and parafoveal inner and outer retinal thickness; microperimetry sensitivity in the central 4° and 8°, ERG b wave amplitudes and peak times, PERG P50 and N95 amplitudes and latencies, and mfERG N1 to P1 amplitudes; and superficial capillary plexus (SCP), deep capillary plexus (DCP) and choriocapillary (CC) plexus vessel densities, divided into foveal and parafoveal region. Results: Retinal thickness, SCP and DCP densities were significantly related to PERG. A significant relationship was found between foveal and parafoveal retinal thicknesses and foveal SCP density (p < 0.001 and p = 0.018, respectively) and between parafoveal retinal thickness and parafoveal SCP density (p = 0.002). Foveal and parafoveal retinal thicknesses were significantly related to parafoveal DCP density (p = 0.007 and p < 0.001). Foveal and parafoveal retinal thicknesses, foveal SCP and parafoveal DPC densities were significantly reduced in CD patients compared to controls (p < 0.001; p = 0.010 and p = 0.008, respectively). PERG and mfERG amplitudes were significantly reduced in CD patients compared to controls (p < 0.01). Conclusions: CD eyes showed reduced retinal thickness significantly related to reduced vessel density, possibly caused by a decreased metabolic demand. In addition, vessel density significantly correlated with loss of function.
Collapse
|
13
|
Reviewing the Role of Ultra-Widefield Imaging in Inherited Retinal Dystrophies. Ophthalmol Ther 2020; 9:249-263. [PMID: 32141037 PMCID: PMC7196101 DOI: 10.1007/s40123-020-00241-1] [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: 01/03/2020] [Indexed: 11/28/2022] Open
Abstract
Inherited retinal dystrophies (IRD) are a heterogeneous group of rare chronic disorders caused by genetically determined degeneration of photoreceptors and retinal pigment epithelium cells. Ultra-widefield (UWF) imaging is a useful diagnostic tool for evaluating retinal integrity in IRD, including Stargardt disease, retinitis pigmentosa, cone dystrophies, and Best vitelliform dystrophy. Color or pseudocolor and fundus autofluorescence images obtained with UWF provide previously unavailable information on the retinal periphery, which correlates well with visual field measurement or electroretinogram. Despite unavoidable artifacts of the UWF device, the feasibility of investigations in infants and in patients with poor fixation makes UWF imaging a precious resource in the diagnostic armamentarium for IRD.
Collapse
|