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Remolí Sargues L, Castro Navarro V, Monferrer Adsuara C, Navarro Palop C, Montero Hernández J, Cervera Taulet E. Optical coherence tomography angiography analysis of choroidal microvasculature in various forms of diabetic macular edema. J Fr Ophtalmol 2024; 47:103950. [PMID: 37758547 DOI: 10.1016/j.jfo.2023.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/27/2023] [Accepted: 03/14/2023] [Indexed: 09/29/2023]
Abstract
INTRODUCTION Optical coherence tomography angiography (OCTA) research in diabetic macular edema (DME) has focused on the retinal microvasculature with little attention to the choroid. The goal of this study was to analyze the association between quantitative choroidal OCTA parameters and various forms of DME observed on optical coherence tomography. METHODS We conducted a retrospective study of 61 eyes of 53 patients with DME. DME was classified as early or advanced, and as sponge-like diffuse retinal thickening (DRT), cystoid macular edema (CME) or serous retinal detachment (SRD). Quantitative OCTA parameters (vessel density [VD] in the superficial capillary plexus [SCP], middle capillary plexus [MCP], deep capillary plexus [DCP] and choriocapillaris [CC]) were recorded. RESULTS The VD in the CC and SCP was significantly higher in patients with early DME compared to patients with advanced DME (P value<0.01). CC VD was lower in subjects with SRD compared to DRT and CME (P value<0.001). Moreover, it was lower in CME compared to DRT (P value<0.05). No statistical differences were found between VD in the MCP and DCP (P value>0.05). Furthermore, CC VD was lower in patients with increased retinal thickness, disruption of the ellipsoid zone (EZ) or external limiting membrane (ELM), and disorganization of the inner retinal layers (DRIL) (P value<0.05). CONCLUSION CC ischemia plays an important role in the pathogenesis of DME. We demonstrated a decrease in CC VD in patients with severe DME, SRD, retinal thickening, EZ and/or ELM disruption and DRIL.
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Affiliation(s)
- L Remolí Sargues
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Av. Tres Cruces 2, 46014 Valencia, Spain.
| | - V Castro Navarro
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Av. Tres Cruces 2, 46014 Valencia, Spain
| | - C Monferrer Adsuara
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Av. Tres Cruces 2, 46014 Valencia, Spain
| | - C Navarro Palop
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Av. Tres Cruces 2, 46014 Valencia, Spain
| | - J Montero Hernández
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Av. Tres Cruces 2, 46014 Valencia, Spain
| | - E Cervera Taulet
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Av. Tres Cruces 2, 46014 Valencia, Spain
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Alamar Pérez B, Hernández Garfella ML, Castro Navarro V, Monferrer Adsuara C, Montero Hernández J, Cervera Taulet E. Autoimmune retinopathy with onconeuronal antibodies: Case report. Arch Soc Esp Oftalmol (Engl Ed) 2022; 97:S2173-5794(22)00139-6. [PMID: 36114140 DOI: 10.1016/j.oftale.2022.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/10/2022] [Indexed: 06/15/2023]
Abstract
We present a case of autoimmune retinopathy in a patient with unknown small cell lung cáncer (SCLC), which was diagnosed after ophthalmological examination. Serology was positive for CV2/CRMP5 onconeuronal antibodies. Autoimmune retinopathy is a rare entity that can be missed and underdiagnosed. It is produced by an immune-mediated reaction against retinal antigens. The importance of its early diagnosis lies in the fact that in many of the patients, ocular symptoms appear before the diagnosis of the primary cancer, so its early identification and referral for an extension study may lead to the diagnosis of a hidden primary neoplasm.
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Affiliation(s)
- B Alamar Pérez
- Servicio de Oftalmología, Hospital General Universitario de Valencia, Valencia, Spain.
| | | | - V Castro Navarro
- Servicio de Oftalmología, Hospital General Universitario de Valencia, Valencia, Spain
| | - C Monferrer Adsuara
- Servicio de Oftalmología, Hospital General Universitario de Valencia, Valencia, Spain
| | - J Montero Hernández
- Servicio de Oftalmología, Hospital General Universitario de Valencia, Valencia, Spain
| | - E Cervera Taulet
- Servicio de Oftalmología, Hospital General Universitario de Valencia, Valencia, Spain
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Monferrer Adsuara C, Remolí Sargues L, Montero Hernández J, Hernández Garfella ML, Hernández Bel L, Castro Navarro V, Cervera Taulet E. Multimodal imaging in multiple evanescent white dot syndrome and new insights in pathogenesis. J Fr Ophtalmol 2021; 44:1536-1544. [PMID: 34728098 DOI: 10.1016/j.jfo.2021.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/02/2021] [Accepted: 05/03/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To report the multimodal imaging in multiple evanescent white dot syndrome (MEWDS) during the acute and convalescent stages in order to better understand the focus of the inflammatory process. METHODS Retrospective cohort study of 4 patients with MEWDS. Each patient underwent: enhanced depth imaging-optical coherence tomography (EDI-OCT), fundus autofluorescence (FAF), fluorescein angiography (FA), indocyanine green angiography (ICGA) and en-face OCT and OCT angiography (OCT-A). Choroidal subfoveal thickness (CST) was measured manually. All patients were studied in the acute stage and convalescent stage after disappearance of OCT abnormalities and resolution of visual symptoms. RESULTS Four MEWDS patients with a mean age of 23.5years were studied (range: 16-33years). Two patients were women. Initial mean visual acuity (VA) was 80.25 ETDRS. Final mean VA was 84.25 ETDRS. OCT imaging showed disruption of the ellipsoid zone and a slightly elevated RPE layer with overlying hyperreflective material, all of which corresponded to hyperautofluorescent FAF lesions. FA revealed multiple hyperautofluorescent lesions, correlated with hypocyanescent spots on the late ICGA. OCT-A showed normal superficial and deep retinal capillary plexus as well as choriocapillaris. The disease was self-limited in all the cases, with a mean time of 9weeks to resolution (range: 4-16). CONCLUSION The pathophysiology of MEWDS is still debated. We believe that there is still not enough evidence to implicate the outer retina as the primary cause. For now, we suggest that this transient disease is the consequence of choriocapillaris hypoperfusion, but further studies are required to elucidate this hypothesis.
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Affiliation(s)
- C Monferrer Adsuara
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, 2 Tres Cruces Avenue, 46014 Valencia, Spain
| | - L Remolí Sargues
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, 2 Tres Cruces Avenue, 46014 Valencia, Spain.
| | - J Montero Hernández
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, 2 Tres Cruces Avenue, 46014 Valencia, Spain
| | - M L Hernández Garfella
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, 2 Tres Cruces Avenue, 46014 Valencia, Spain
| | - L Hernández Bel
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, 2 Tres Cruces Avenue, 46014 Valencia, Spain
| | - V Castro Navarro
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, 2 Tres Cruces Avenue, 46014 Valencia, Spain
| | - E Cervera Taulet
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, 2 Tres Cruces Avenue, 46014 Valencia, Spain
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Remolí-Sargues L, Montero-Hernández J, Monferrer Adsuara C, Castro Navarro V, Cervera-Taulet E. Perifoveal exudative vascular anomalous complex treated with navigated retina laser. J Fr Ophtalmol 2021; 45:e9-e11. [PMID: 34340884 DOI: 10.1016/j.jfo.2021.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 03/02/2021] [Accepted: 03/18/2021] [Indexed: 10/20/2022]
Affiliation(s)
- L Remolí-Sargues
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, avenue Tres Cruces 2, 46014 Valencia, Spain.
| | - J Montero-Hernández
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, avenue Tres Cruces 2, 46014 Valencia, Spain
| | - C Monferrer Adsuara
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, avenue Tres Cruces 2, 46014 Valencia, Spain
| | - V Castro Navarro
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, avenue Tres Cruces 2, 46014 Valencia, Spain
| | - E Cervera-Taulet
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, avenue Tres Cruces 2, 46014 Valencia, Spain
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Monferrer Adsuara C, Remolí Sargues L, Mata Moret L, Castro Navarro V, Montero-Hernández J. Multimodal imaging features in retinal racemose hemangioma. J Fr Ophtalmol 2021; 44:1087-1088. [PMID: 34226084 DOI: 10.1016/j.jfo.2020.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 12/01/2020] [Indexed: 11/15/2022]
Affiliation(s)
- C Monferrer Adsuara
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Av. Tres Cruces 2, 46014 Valencia, Spain
| | - L Remolí Sargues
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Av. Tres Cruces 2, 46014 Valencia, Spain.
| | - L Mata Moret
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Av. Tres Cruces 2, 46014 Valencia, Spain
| | - V Castro Navarro
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Av. Tres Cruces 2, 46014 Valencia, Spain
| | - J Montero-Hernández
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Av. Tres Cruces 2, 46014 Valencia, Spain
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Ortiz Salvador M, Montero Hernández J, Castro Navarro V, Cervera Taulet E, Navarro Palop C, Monferrer Adsuara C, Remolí Sargues L, Gonzalez Girón N. Multimodal imaging in phototoxic maculopathy: description of findings in a series of 12 patients. Arch Soc Esp Oftalmol (Engl Ed) 2021; 96:133-140. [PMID: 33012549 DOI: 10.1016/j.oftal.2020.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To study the differences between solar retinopathy (SR) and the maculopathy produced by laser pointer (LPM) using multimodal imaging. METHOD A retrospective series is presented of 20 eyes of 12 patients with injuries associated with light, 7 with SR-compatible injuries, and 5 with LPM. At diagnosis, a complete ophthalmological examination was performed, including visual acuity (VA), retinography, and spectral domain optical coherence tomography (OCT). The patients were followed-up for a mean period of 20 months. RESULTS LPM is common in paediatrics (mean age 15.60±1.5years), and SR affects patients of all ages (mean age 47.56±1.51years). VA at diagnosis in LPM is greater, and recovery is more complete than in solar retinopathy. In conventional retinography, SR is shown as a single lesion in the macular area (100% of cases), while LPM usually presents as multifocal lesions (86% of cases). Infrared reflectance makes this difference clearer. The main sign in OCT is the disruption of the ellipsoid layer and interdigitation zone. This sign is maintained over time, and its size is greater in the SR than in the LPM. Hyper-reflective columns and hyper-reflective reaction of the retinal pigment epithelium are associated with the acute phase. CONCLUSIONS LPM and SR show significant differences in the type of patient affected, as well as in the signs in multimodal imaging, as well as in functional impairment and their evolution.
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Affiliation(s)
- M Ortiz Salvador
- Servicio de Oftalmología, Hospital General Universitario de Valencia, Valencia, España.
| | - J Montero Hernández
- Servicio de Oftalmología, Hospital General Universitario de Valencia, Valencia, España
| | - V Castro Navarro
- Servicio de Oftalmología, Hospital General Universitario de Valencia, Valencia, España
| | - E Cervera Taulet
- Servicio de Oftalmología, Hospital General Universitario de Valencia, Valencia, España
| | - C Navarro Palop
- Servicio de Oftalmología, Hospital General Universitario de Valencia, Valencia, España
| | - C Monferrer Adsuara
- Servicio de Oftalmología, Hospital General Universitario de Valencia, Valencia, España
| | - L Remolí Sargues
- Servicio de Oftalmología, Hospital General Universitario de Valencia, Valencia, España
| | - N Gonzalez Girón
- Servicio de Oftalmología, Hospital General Universitario de Valencia, Valencia, España
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Hernández Bel L, Esteve Martínez A, Rodríguez López R, Monferrer Adsuara C, Hernández Garfella ML, Cervera Taulet E. Pseudoxanthoma elasticum in childhood in patient with β-thalassaemia. Arch Soc Esp Oftalmol (Engl Ed) 2020; 95:555-558. [PMID: 32593604 DOI: 10.1016/j.oftal.2020.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/10/2020] [Accepted: 05/15/2020] [Indexed: 06/11/2023]
Abstract
Pseudoxanthoma elasticum (PXE) is a rare genetic disorder characterised by elastic tissue alterations and caused by mutations in a single gene, ABCC6, on chromosome 16p that includes manifestations that are predominantly cutaneous, ocular and cardiovascular. PXE-like lesions in association with β-thalassemia have previously been reported in the literature in patients with β-thalassaemia intermediate and major, being clinically indistinguishable from classic PXE. The case is presented of a 10-year-old boy with β-thalassaemia minor and characteristic lesions of PXE. It is worth noting the benefit of multimodal imaging in the diagnosis and monitoring of the lesions.
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Affiliation(s)
- L Hernández Bel
- Departamento de Oftalmología, Hospital General, Valencia, España.
| | | | | | | | | | - E Cervera Taulet
- Departamento de Oftalmología, Hospital General, Valencia, España
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Remolí Sargues L, Montero Hernández J, Monferrer Adsuara C, Navarro Palop C, Cervera Taulet E. Colloid drusen: A type of early-onset drusen. Arch Soc Esp Oftalmol (Engl Ed) 2020; 95:e14. [PMID: 31879140 DOI: 10.1016/j.oftal.2019.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 11/10/2019] [Indexed: 06/10/2023]
Affiliation(s)
- L Remolí Sargues
- Servicio de Oftalmología, Hospital General Universitario de Valencia, Valencia, España.
| | - J Montero Hernández
- Servicio de Oftalmología, Hospital General Universitario de Valencia, Valencia, España
| | - C Monferrer Adsuara
- Servicio de Oftalmología, Hospital General Universitario de Valencia, Valencia, España
| | - C Navarro Palop
- Servicio de Oftalmología, Hospital General Universitario de Valencia, Valencia, España
| | - E Cervera Taulet
- Servicio de Oftalmología, Hospital General Universitario de Valencia, Valencia, España
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Hernández Bel L, Monferrer Adsuara C, Hernández Garfella M, Cervera Taulet E. Early macular toxicity following 2 months of hydroxychloroquine therapy. Arch Soc Esp Oftalmol (Engl Ed) 2018; 93:e20-e21. [PMID: 29395216 DOI: 10.1016/j.oftal.2017.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 12/05/2017] [Indexed: 06/07/2023]
Affiliation(s)
- L Hernández Bel
- Servicio de Oftalmología, Hospital General Universitario de Valencia, Valencia, España.
| | - C Monferrer Adsuara
- Servicio de Oftalmología, Hospital General Universitario de Valencia, Valencia, España
| | - M Hernández Garfella
- Servicio de Oftalmología, Hospital General Universitario de Valencia, Valencia, España
| | - E Cervera Taulet
- Servicio de Oftalmología, Hospital General Universitario de Valencia, Valencia, España
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