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Errera C, Romann J, Solecki L, Gaucher D, Ballonzoli L, Bourcier T, Sauer A. Retinal microvascular changes in unilateral functional amblyopia detected by oct-angiography and follow-up during treatment. Eur J Ophthalmol 2024; 34:399-407. [PMID: 37464746 DOI: 10.1177/11206721231188987] [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] [Indexed: 07/20/2023]
Abstract
OBJECTIVE To evaluate the macular microvascular changes using optical coherence tomographic angiography (OCT-A) in children with unilateral amblyopia and their reversibility during treatment. METHODS Patients with unilateral strabismic or anisometropic amblyopia or residual amblyopia from early congenital cataract surgery, examined between October 2019 and March 2021, were included. Vessel density and perfusion density in the superficial capillary plexus and area, perimeter and circularity of the foveal avascular zone (FAZ) were analysed using OCT-A in amblyopic eyes, contralateral eyes and control group healthy eyes. Correlation analyses between the microvascular parameters and the visual acuity were performed. In a pilot study on a few patients from the amblyopic cohort, longitudinal follow-up during treatment was also performed. RESULTS A total of 128 eyes of 64 patients were included: 32 amblyopic eyes compared with 32 contralateral eyes and 64 control eyes. Vessel density and perfusion density in the superficial capillary plexus were significantly lower in amblyopic eyes compared to control eyes in 6 × 6 mm (p < 0.02) and 3 × 3 mm (p < 0.01) scans. Correlation analyses showed a linear decrease in vessel density and perfusion density with decreasing visual acuity. The microvascular changes observed were reversible with the occlusion treatment of amblyopia (p < 0.001). CONCLUSIONS The study found a decrease in vessel density and perfusion density in the macula of children with unilateral functional amblyopia. These microvascular changes were correlated with visual acuity and appeared to be reversible with treatment of amblyopia. On the whole, OCT-A appears to be a relevant complementary examination when it comes to diagnosing and monitoring functional amblyopia.
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Affiliation(s)
- Charlotte Errera
- Department of Ophthalmology, Strasbourg University Hospital, FMTS, Strasbourg, France
| | - Julia Romann
- Department of Ophthalmology, Strasbourg University Hospital, FMTS, Strasbourg, France
| | - Lauriana Solecki
- Department of Ophthalmology, Strasbourg University Hospital, FMTS, Strasbourg, France
| | - David Gaucher
- Department of Ophthalmology, Strasbourg University Hospital, FMTS, Strasbourg, France
| | - Laurent Ballonzoli
- Department of Ophthalmology, Strasbourg University Hospital, FMTS, Strasbourg, France
| | - Tristan Bourcier
- Department of Ophthalmology, Strasbourg University Hospital, FMTS, Strasbourg, France
| | - Arnaud Sauer
- Department of Ophthalmology, Strasbourg University Hospital, FMTS, Strasbourg, France
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Naderi Beni A, Dehghani A, Peyman M, Baghshahi S, Sattari N, Hoseinzadeh S. Evaluation of Ganglion Cell-Layer Complex and Macular Vessel Density in Amblyopic Eyes with Optical Coherence Tomography Angiography. Photobiomodul Photomed Laser Surg 2024; 42:66-80. [PMID: 38252490 DOI: 10.1089/photob.2023.0053] [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] [Indexed: 01/24/2024] Open
Abstract
Purpose: This study aimed to compare and quantify the ganglion cell complex (GCC), macular thickness, and vessel density (VD) in amblyopic eyes and their corresponding fellow eyes using optical coherence tomography angiography (OCTA). Methods: This cross-sectional study analyzed 32 unilateral amblyopic patients, examining both of their eyes. The study assessed parameters such as GCC thickness, macular thickness (total, inner, and outer layers), and VD in the optic nerve and macular region using spectral-domain OCTA. Results: This study analyzed data from 30 unilateral amblyopic patients with a mean age of 28.7 ± 18.3 years. Amblyopic eyes had lower mean best-corrected visual acuity compared with healthy eyes. However, no significant differences were found in retinal nerve fiber layer (RNFL) thickness, GCC thickness, and overall retinal thickness between amblyopic and fellow eyes when accounting for factors such as axial length and signal strength index. In patients older than 30 years, amblyopic eyes had a higher global loss volume (GLV) compared with fellow eyes (p = 0.02). In addition, blood VD within the optic disc and superficial/deep capillary plexuses in different macular regions were significantly lower in amblyopic eyes compared with fellow eyes. Conclusions: This study found significant differences in VD and the GLV index between amblyopic eyes and healthy eyes, particularly in older patients. However, there were no notable differences in macular thickness and RNFL thickness. Further research is needed to determine the clinical relevance of these findings.
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Affiliation(s)
- Afsaneh Naderi Beni
- Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Dehghani
- Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammadreza Peyman
- Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sajjad Baghshahi
- Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Niloofar Sattari
- Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Safoura Hoseinzadeh
- Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Yang CC, Ji KB, Yu YF. Analysis of Retinal Microvasculature Features in Amblyopic Eyes: A Meta-Analysis. Ophthalmic Res 2022; 66:131-143. [PMID: 35998587 DOI: 10.1159/000526531] [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: 05/05/2022] [Accepted: 08/10/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Amblyopia is a common cause of visual disorder with several changes in retinal structure and vessel. To date, alterations in retinal microvasculature features in amblyopia have yielded inconsistent results. OBJECTIVES This meta-analysis aimed to evaluate retinal vessel density (VD) in amblyopic patients using optical coherence tomography angiography (OCTA). METHODS PubMed, Web of Science, Embase, and Cochrane Library databases were systematically searched for published articles comparing retinal microvasculature characteristics in patients with amblyopia and controls. Continuous variable outcomes were assessed using the mean difference (MD) with a 95% confidence interval. Review Manager Version 5.30 was used for the analysis. RESULTS Thirteen qualified articles were pooled in this meta-analysis. Compared with controls, the foveal whole en face VD of superficial capillary plexus (SCP) and deep capillary plexus (DCP) of patients as measured by 3 × 3-mm scans were significantly lower in amblyopia eyes (MD: -1.37, p = 0.0003; MD: 1.70, p < 0.00001, respectively). Similarly, in the 6 × 6-mm scans, foveal whole en face VD of the SCP and DCP were remarkably lower in amblyopia eyes than in controls (MD: -2.24, p = 0.03; MD: -5.08, p = 0.04, respectively). The parafoveal VD of SCP in 3 × 3-mm scans (MD: -1.96, p < 0.00001) was also lower in amblyopic patients than in controls. Similarly, in 6 × 6-mm scans, amblyopia eyes showed a significant decrease and a trending decrease in the parafoveal VD of the SCP (MD: -3.85, p = 0.007) and DCP (MD: -3.03, p = 0.10), respectively. For whole radial peripapillary capillary (RPC), VD was significantly reduced in amblyopic patients compared to controls (MD = -0.83, p < 0.00001). In addition, the deep foveal avascular zone (FAZ) was larger in amblyopic eyes than in the controls (MD = 0.55, p = 0.007). CONCLUSIONS Our data suggest that whole foveal and parafoveal VD and RPC whole VD were reduced in patients with amblyopia. Moreover, our results reveal that the FAZ is larger in amblyopic patients. Consequently, OCTA may have the potential for diagnosing and monitoring patients with amblyopia.
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Affiliation(s)
- Chong-Chao Yang
- Department of Ophthalmology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- The Fourth School of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Kai-Bao Ji
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China,
| | - Yi-Feng Yu
- Department of Ophthalmology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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Karabulut M, Karabulut S, Sül S, Karalezli A. Microvascular differences in amblyopic subgroups: An observational case-control study. Eur J Ophthalmol 2021; 32:11206721211065852. [PMID: 34859717 DOI: 10.1177/11206721211065852] [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: 11/16/2022]
Abstract
PURPOSE To determine retinal microvascular differences among amblyopic subgroups and compare them with control eyes. STUDY DESIGN This study was designed as an observational case-control study. METHODS Twenty-three strabismic, 23 anisometropic, 22 meridional, 22 ametropic amblyopic eyes, and 24 healthy control eyes were included. The mean vessel densities in the deep and superficial capillary plexus, the foveal avascular zone area, the choriocapillaris flow area, and the foveal thickness were compared. RESULTS Vessel density was markedly lower in all sectors of the amblyopic subgroups in the deep capillary plexus than in control eyes. Density was significantly lower in the superficial capillary plexus only in ametropic and meridional amblyopic eyes. Among these groups, the meridional amblyopic eyes had the largest choriocapillaris flow area (p = 0.013) and the lowest vessel density in all sectors (p < 0.001). The foveal avascular zone area was similar in all groups (p = 0.561). The fovea was significantly thicker only in the anisometropic and meridional subgroups than control eyes (p = 0.011, p = 0.001, respectively). The foveal avascular zone area was inversely related to the foveal thickness in all groups. CONCLUSION Retinal structural and microvascular differences were found among amblyopic subgroups. Optical coherence tomography angiography can noninvasively detect these variations, which may be related to the etiologic factors.
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Affiliation(s)
- Müjdat Karabulut
- 52986Mugla Sıtkı Koçman University Medical School, Department of Ophthalmology, Mugla, Turkey
| | - Sinem Karabulut
- 52986Mugla Sıtkı Koçman University Medical School, Department of Ophthalmology, Mugla, Turkey
| | - Sabahattin Sül
- 52986Mugla Sıtkı Koçman University Medical School, Department of Ophthalmology, Mugla, Turkey
| | - Aylin Karalezli
- 52986Mugla Sıtkı Koçman University Medical School, Department of Ophthalmology, Mugla, Turkey
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OCT-Angiography Findings in Patients with Amblyopia: Comparison between Healthy Controls, Treatment-Responsive, and Treatment-Unresponsive Amblyopic Patients. Diagnostics (Basel) 2021; 11:diagnostics11101751. [PMID: 34679448 PMCID: PMC8534794 DOI: 10.3390/diagnostics11101751] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/13/2021] [Accepted: 09/20/2021] [Indexed: 11/16/2022] Open
Abstract
There is no consensus on whether amblyopia affects the retinal vascular plexus and morphology. Previous studies focused on the differences between amblyopic patients and normal controls without evaluating amblyopic eyes after patching. To evaluate differences in the superficial vascular density of amblyopic eyes, normal eyes, and amblyopic eyes reaching normal BCVA after patch therapy, OCTA was used. All patients underwent a comprehensive ophthalmological examination, including visual acuity, refraction, ocular motility tests, and anterior and posterior segment examination. OCTA was performed by an expert physician using the Zeiss Cirrus 5000-HD-OCT Angioplex (Carl Zeiss, Meditec, Inc., Dublin, OH, USA). OCTA scans were performed using a 3 × 3 mm2 and 6 × 6 mm2 fovea-centered image setting. The mean outer macular vessel density in the previously amblyopic group was 19.15 ± 0.51%. This was statistically significantly higher than in both the amblyopic group (18.70 ± 1.14%) and the normal controls (18.18 ± 1.40%) (p = 0.014). The previously amblyopic group also significantly differed from both normal controls and amblyopic eyes with regards to the inner (p = 0.011), outer (p = 0.006), and full (p = 0.003) macular perfusion. Finally, linear regression analysis revealed that BCVA was linearly correlated to outer perfusion in amblyopic (p = 0.003) and ex amblyopic eyes (p < 0.001). Considering the cross-sectional nature of our study, from our results, we can only hypothesize a possible correlation between light stimulation and retinal vasculature development. However, further longitudinal studies are needed to support this hypothesis.
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Pujari A, Saluja G, Chawla R, Samdani A, Phuljhele S, Saxena R. Optical coherence tomography angiography in amblyopia: A critical update on current understandings and future perspectives. Eur J Ophthalmol 2021; 32:1324-1332. [PMID: 34472984 DOI: 10.1177/11206721211042554] [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: 11/15/2022]
Abstract
Optical coherence tomography angiography (OCTA) is a non-invasive tool to assess the retino-choroidal vasculature in vivo. It tracks the red blood cell movement and maps the vasculature in quick succession. In routine, diabetic retinopathy, age related macular degeneration, central serous chorioretinopathy, and others are commonly being studied to unveil its clinic role. On the other hand, amblyopia is a condition where the visual acuity is subnormal due to non-organic causes in the eye. But the OCTA studies till now have shown variable changes along retino-choroidal vasculature. Hence, to comprehend the existing literature knowledge, a systematic literature search was carried out and the original works describing novel findings in amblyopic eyes on OCTA were included. Upon detailed assessment, firstly, the disturbed vasculature along superficial retinal plexus, deeper retinal plexus, and choroidal plexus were evident in most untreated amblyopic eyes. However, such changes were not uniform, which is due to noted heterogenic patient profile, small sample size, biometric biases, non-uniform algorithms, and other factors. And to note, even in presence of such diverse changes, almost all the authors stated a plausible explanation for their notable changes. Secondly, the utility of OCTA in identifying vascular changes with standard treatments and segregation of visual beneficiaries from non-beneficiaries were possible. Hence, to conclude, OCTA is a valuable tool which can provide valuable useful insights into the amblyopic eyes during pre and post treatment periods. However, to gather more concrete evidence for clinical benefits, systematic, homogenous, and better structured clinical studies are mandated.
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Affiliation(s)
- Amar Pujari
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Gunjan Saluja
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rohan Chawla
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Asha Samdani
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Swati Phuljhele
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Saxena
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Zhai J, Fang W, Yu X, Ye X, Hou L. Macular perfusion density evaluation in constant and intermittent exotropia by means of optical coherence tomography angiography. BMC Ophthalmol 2021; 21:254. [PMID: 34103021 PMCID: PMC8188649 DOI: 10.1186/s12886-021-02006-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 05/18/2021] [Indexed: 11/30/2022] Open
Abstract
Background To quantify and compare retinal microvascular features using optical coherence tomography angiography (OCTA) in constant (XT) and intermittent exotropia (IXT). Methods An observational cross-sectional study was conducted from September 2020 to November 2020 at the Affiliated Eye Hospital of Wenzhou Medical University. OCTA examination was performed to evaluate the macular perfusion density of the deep capillary plexus (DCP), superficial capillary plexus (SCP), and foveal avascular zone (FAZ) parameters in XT and IXT patients, and in age-matched controls. The study parameters were analyzed. Results A total of 76 participants, including 16 (21%) XT patients, 24 (32%) IXT patients, and 36 (47%) controls, were recruited. The exodeviation angle was 39.06 ± 10.38 prism degrees (PD) at near and 43.00 ± 9.74 PD at distance in the XT group, and 27.13 ± 18.28 PD at near and 31.04 ± 18.82 PD at distance in the IXT group. The macular perfusion density of the DCP in 6 × 6-mm scans and the SCP in 3 × 3-mm scans were lower in the deviating eyes than in the fixating eyes of XT patients (p < 0.001, p = 0.032, respectively). The macular perfusion density of the DCP in the deviating eyes of XT and IXT patients was significantly lower than that of the controls. There was no significant difference in the FAZ parameters among the groups. Conclusions In XT patients, OCTA revealed lower macular perfusion density in deviating eyes than in fixating eyes and control eyes. IXT patients showed no difference between the two eyes, but the macular perfusion density of the DCP was lower than that of the controls.
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Affiliation(s)
- Jing Zhai
- Department of Strabismus and Amblyopia, Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, 310016, Zhejiang Province, China
| | - Wei Fang
- Department of Strabismus and Amblyopia, Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, 310016, Zhejiang Province, China
| | - Xueting Yu
- Department of Strabismus and Amblyopia, Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, 310016, Zhejiang Province, China
| | - Xinjie Ye
- Department of Strabismus and Amblyopia, Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, 310016, Zhejiang Province, China
| | - Lijie Hou
- Department of Strabismus and Amblyopia, Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, 310016, Zhejiang Province, China.
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Cinar E, Yuce B, Aslan F, Erbakan G. Comparison of Retinal Vascular Structure in Eyes With and Without Amblyopia by Optical Coherence Tomography Angiography. J Pediatr Ophthalmol Strabismus 2020; 57:48-53. [PMID: 31972041 DOI: 10.3928/01913913-20191004-01] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 08/30/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the retinal vascular structure in amblyopic eyes by optical coherence tomography angiography (OCTA). METHODS Thirty-seven eyes of 37 patients with anisometric amblyopia were compared with 37 eyes of 37 age- and gender-matched control subjects by OCTA in terms of superficial capillary plexus vessel density, deep capillary plexus vessel density, and foveal avascular zone. RESULTS The mean age was 12 ± 4.2 years in patients with amblyopia and 13 ± 6.1 years in individuals without amblyopia. Foveal superficial capillary plexus vessel densities were 20.49% ± 3.27%, 19.70% ± 3.82%, and 19.96% ± 3.84%, and parafoveal superficial capillary plexus vessel densities were 48.50% ± 3.64%, 49.01% ± 3.33%, and 48.9% ± 2.98% in amblyopic, fellow, and control eyes, respectively. The foveal deep capillary plexus vessel densities were 18.95% ± 3.76%, 18.6% ± 4.50%, and 19.29% ± 4.01%, and parafoveal deep capillary plexus vessel densities were 51.0% ± 4.21%, 51.85% ± 4.12%, and 52.03% ± 3.57% in amblyopic, fellow, and control eyes, respectively. Superficial and deep capillary plexus vessel densities in the foveal and parafoveal areas were not significantly different between the groups (P > .05). The parafoveal area was evaluated in quadrants. In the superior quadrant, superficial and deep capillary plexus parafoveal densities were significantly lower in amblyopic eyes (P < .05). No significant difference was observed in the foveal avascular zone between the groups (P > .05). CONCLUSIONS Although no significant vascular damage was demonstrated by OCTA in amblyopic eyes, localized defects may be specific for it. Additional studies are needed to evaluate any specific localization of vascular damage related to amblyopia. [J Pediatr Ophthalmol Strabismus. 2020;57(1):48-53.].
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