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Caplash S, Paez-Escamilla M, Westcott M, Dansingani KK, Indermill C, Kisma N, Frau E, Sahel JA, Bodaghi B, Jhanji V, Errera MH. Mimickers of anterior uveitis, scleritis and misdiagnoses- tips and tricks for the cornea specialist. J Ophthalmic Inflamm Infect 2024; 14:14. [PMID: 38594487 PMCID: PMC11004105 DOI: 10.1186/s12348-024-00396-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 03/29/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Anterior uveitis, inflammation of the anterior chamber and related structures, is a cohort of diseases that can present to almost any general or sub-specialty Ophthalmology practice. Its features classically involve anterior chamber cell and flare. Below the surface of these two signs exist a panoply of diagnoses. BODY: The purpose of this review is to provide a general framework for diagnoses of anterior uveitis that are often missed as well as non-uveitic pathologies that often mimic anterior uveitis. Diagnostic deviation in either direction can have vision-threatening and rarely life-threatening consequences for patients. Using a comprehensive literature review we have collected a broad spectrum of etiologies of anterior uveitis that are easily missed and non-uveitic pathologies that can masquerade as anterior uveitis. CONCLUSIONS We present a focused review on specific misdiagnosed anterior uveitis pathologies and some of the conditions that can masquerade as anterior uveitis and scleritis.
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Affiliation(s)
- Sonny Caplash
- Department of Ophthalmology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Manuel Paez-Escamilla
- Department of Ophthalmology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Mark Westcott
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, UK
| | - Kunal K Dansingani
- Department of Ophthalmology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Chad Indermill
- Department of Ophthalmology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Nacima Kisma
- Universite Libre de Bruxelles, Hopital Universitaire de Bruxelles, 808 route de Lennik 1170, Bruxelles, Belgium
| | - Eric Frau
- Department of Ophthalmology, Centre hospitalier National des Quinze-Vingts, Paris, France
| | - Jose-Alain Sahel
- Department of Ophthalmology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Bahram Bodaghi
- Department of Ophthalmology, Pitié-Salpêtrière University Hospital, Sorbonne Universités, F-75013, Paris, France
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Marie-Helene Errera
- Department of Ophthalmology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA, 15213, USA.
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Adeghate JO, Yadav S, Kowalski RP, Juhász E, Kristóf K, Olsen KR, Bergren RL, Knickelbein JE, Chhablani J, Martel JN, Anetakis A, Dansingani KK, Rosin B, Gallagher DS, Prensky C, Eller AW, Friberg T, Sahel JA, Errera MH. Coagulase-negative staphylococcal endophthalmitis: clinical severity and outcomes based on speciation. Can J Ophthalmol 2023:S0008-4182(23)00175-8. [PMID: 37321555 DOI: 10.1016/j.jcjo.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 04/17/2023] [Accepted: 05/25/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To identify characteristics and visual outcomes of coagulase-negative staphylococci (CoNS) endophthalmitis in the era after the Endophthalmitis Vitrectomy Study. DESIGN Single-centre retrospective analysis. PARTICIPANTS Forty-two samples from 40 patients with documented CoNS endophthalmitis. METHODS Visual acuity outcomes of patients with CoNS endophthalmitis were assessed in relation to species and type of treatment instituted (e.g., pars plana vitrectomy [PPV] versus tap and injection of intravitreal antibiotics [T&I]). Strains were speciated using Gram and Giemsa staining and were further identified using API Staph and Biolog GEN III microplates. Genetic analysis was performed via polymerase chain reaction. Antibiotic susceptibility was assessed with disk diffusion. RESULTS Staphylococcus epidermidis was the most prevalent CoNS in our study. Cataract surgery and intravitreal injections were the most common sources for acute CoNS endophthalmitis. Eyes presenting with hand motion or better vision had similar mean final vision after either intravitreal antibiotics or PPV, whereas those with light perception or worse vision at onset had better outcomes after PPV only. Subanalysis showed that patients with S. epidermidis endophthalmitis (n = 39 eyes) had similar visual outcomes with either intravitreal injections or PPV regardless of visual acuity. Hypopyon and vitritis are not always present. CONCLUSIONS Patients with S. epidermidis endophthalmitis may benefit similarly from either early vitrectomy or intravitreal antibiotic injections regardless of visual acuity. This finding complements the management standards set forth by the Endophthalmitis Vitrectomy Study.
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Affiliation(s)
- Jennifer O Adeghate
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pa; Institute of Laboratory Medicine, Semmelweis University, Budapest, Hungary.
| | - Sanya Yadav
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pa
| | - Regis P Kowalski
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pa; Charles T. Campbell Microbiology Laboratory, University of Pittsburgh, Pittsburgh, Pa
| | - Emese Juhász
- Institute of Laboratory Medicine, Semmelweis University, Budapest, Hungary
| | - Katalin Kristóf
- Institute of Laboratory Medicine, Semmelweis University, Budapest, Hungary
| | | | | | | | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pa
| | - Joseph N Martel
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pa
| | | | | | - Boris Rosin
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pa
| | | | - Colin Prensky
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pa
| | - Andrew W Eller
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pa
| | - Thomas Friberg
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pa
| | - José-Alain Sahel
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pa
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Melachuri S, Dansingani KK, Wesalo J, Paez-Escamilla M, Gagrani M, Atta S, Indermill C, Sahel JA, Nischal KK, Chhablani J, Errera MH. OCT Angiography in Noninfectious Uveitis: A Description of Five Cases and Clinical Applications. Diagnostics (Basel) 2023; 13:diagnostics13071296. [PMID: 37046514 PMCID: PMC10092962 DOI: 10.3390/diagnostics13071296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 04/01/2023] Open
Abstract
Background: Optical coherence tomography angiography (OCTA) is a noninvasive imaging modality used to analyze the retinochoroidal vasculature and detect vascular flow. The resulting images can be segmented to view each vascular plexus individually. While fluorescein angiography is still the gold standard for the diagnosis of posterior uveitis, it has limitations, and can be replaced by OCTA in some cases. Methods: This case series describes five patients with posterior noninfectious uveitis and their description by OCTA. Results: Cases included lupus retinopathy (n = 1) for which OCTA showed ischemic maculopathy as areas of flow deficit at the superficial and deep capillary plexus; choroidal granulomas (n = 1) with a non-detectable flow signal in the choroid; active punctate inner choroiditis and multifocal choroiditis (n = 1) with OCTA that showed active inflammatory chorioretinal lesions as non-detectable flow signals in choriocapillaris and choroid; dense type 2 inflammatory secondary neovascularization (n = 1) associated with active choroiditis; and acute posterior multifocal placoid pigment epitheliopathy (APMPPE) (n = 1) without flow abnormalities at the superficial and deep retinal plexuses but non-detectable flow at the levels of the choriocapillaris and choroid. Conclusions: Ophthalmologists can use OCTA to identify inflammatory changes in retinal and choroidal vasculature, aiding in the diagnosis, management, and monitoring of posterior uveitis.
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Vienola KV, Lejoyeux R, Gofas-Salas E, Snyder VC, Zhang M, Dansingani KK, Sahel JA, Chhablani J, Rossi EA. Autofluorescent hyperreflective foci on infrared autofluorescence adaptive optics ophthalmoscopy in central serous chorioretinopathy. Am J Ophthalmol Case Rep 2022; 28:101741. [PMID: 36345414 PMCID: PMC9636439 DOI: 10.1016/j.ajoc.2022.101741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/12/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose To test the hypothesis that hyperreflective foci in central serous chorioretinopathy (CSCR) are autofluorescent and may represent macrophages that have engulfed outer retinal fluorophores from the retinal pigment epithelium (RPE) and photoreceptors. Methods Enrolled subjects underwent spectral domain and swept-source optical coherence tomography, adaptive optics flood-illumination, and adaptive optics scanning laser ophthalmoscopy (AOSLO), including near-infrared autofluorescence (AO-IRAF). For the AO-IRAF imaging, retinal fluorophores were excited using 795 nm light and collected in an emission band from 814 to 850 nm. Results In 2 of 3 eyes, a hyperautofluorescent signal was detected with an elliptical shape and punctate, granular aspects surrounded by a hypoautofluorescent halo. The size of these structures in the active case was measured to be 17 ± 4 μm in diameter, with at least 45 individual hyperautofluorescent foci identified from the AO-IRAF montage in the active stage of patient 2. In the asymptomatic case there were fewer structures visible (∼10) and their size was smaller (11 ± 4 μm). These hyper-AF foci were colocalized with hyperreflective foci on OCT and visible in simultaneously acquired confocal AOSLO images in active stage. The hyperautofluorescent foci in the patient with active CSCR disappeared coincident with clinical resolution. Conclusion and importance We show here the first AO-IRAF images from patients with CSCR, demonstrating hyper-autofluorescent punctate foci, colocalized with hyper-reflective foci on confocal AOSLO images and in OCT. The autofluorescence of these foci may be driven by the accumulation of photoreceptor and RPE fluorophores within macrophages during the active stage of the disease.
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Affiliation(s)
- Kari V. Vienola
- University of Pittsburgh, Department of Ophthalmology, School of Medicine, 4200 Fifth Ave, Pittsburgh, PA, USA
- Corresponding author. Laboratory of Biophysics, Institute of Biomedicine University of Turku Tykistönkatu 6A, Turku, Finland.
| | - Raphael Lejoyeux
- University of Pittsburgh, Department of Ophthalmology, School of Medicine, 4200 Fifth Ave, Pittsburgh, PA, USA
- Rothschild Foundation Hospital, 29 rue Manin, Paris, France
| | - Elena Gofas-Salas
- University of Pittsburgh, Department of Ophthalmology, School of Medicine, 4200 Fifth Ave, Pittsburgh, PA, USA
| | - Valerie C. Snyder
- University of Pittsburgh, Department of Ophthalmology, School of Medicine, 4200 Fifth Ave, Pittsburgh, PA, USA
| | - Min Zhang
- University of Pittsburgh, Department of Ophthalmology, School of Medicine, 4200 Fifth Ave, Pittsburgh, PA, USA
| | - Kunal K. Dansingani
- University of Pittsburgh, Department of Ophthalmology, School of Medicine, 4200 Fifth Ave, Pittsburgh, PA, USA
| | - José-Alain Sahel
- University of Pittsburgh, Department of Ophthalmology, School of Medicine, 4200 Fifth Ave, Pittsburgh, PA, USA
| | - Jay Chhablani
- University of Pittsburgh, Department of Ophthalmology, School of Medicine, 4200 Fifth Ave, Pittsburgh, PA, USA
| | - Ethan A. Rossi
- University of Pittsburgh, Department of Ophthalmology, School of Medicine, 4200 Fifth Ave, Pittsburgh, PA, USA
- University of Pittsburgh, Department of Bioengineering, Swanson School of Engineering, Pittsburgh, PA, USA
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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5
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Amarasekera S, Williams AM, Freund KB, Rossi EA, Dansingani KK. MULTIMODAL IMAGING OF MULTIFOCAL CHOROIDITIS WITH ADAPTIVE OPTICS OPHTHALMOSCOPY. Retin Cases Brief Rep 2022; 16:747-753. [PMID: 36288621 PMCID: PMC9606444 DOI: 10.1097/icb.0000000000001134] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To describe longitudinal, anatomical, and functional alterations caused by inflammatory and neovascular lesions of idiopathic multifocal choroiditis/punctate inner choroidopathy using adaptive optics imaging and microperimetry. METHODS Longitudinal case study using multiple imaging modalities, including spectral-domain optical coherence tomography, fluorescein angiography, indocyanine green angiography, optical coherence tomography angiography, flood illumination adaptive optics, and microperimetry. RESULTS A 21-year-old myopic Asian man presented with blurred vision in the right eye. Clinical examination was notable for an isolated hypopigmented, perifoveal lesion in each eye. Multimodal imaging showed inflammatory lesions in the outer retina, retina pigment epithelium, and inner choroid lesions of both eyes. The right eye additionally exhibited active Type-2 macular neovascularization with loss of cone mosaic regularity that was associated with reduced sensitivity on microperimetry. The clinical picture was consistent with multifocal choroiditis/punctate inner choroidopathy. The patient was treated with oral steroids and three injections of intravitreal bevacizumab in the right eye. After therapy, imaging showed reestablishment of the cone mosaic on flood illumination adaptive optics and improvement in sensitivity on microperimetry. CONCLUSION Adaptive optics imaging and microperimetry may detect biomarkers that help to characterize the nature and activity of multifocal choroiditis lesions and to help monitor response to therapy. With timely intervention, structural abnormalities in the outer retina and choroid can be treated, and anatomical improvements precede improvements in visual function.
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Affiliation(s)
- Sohani Amarasekera
- Department of Ophthalmology, Eye and Ear Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Andrew M. Williams
- Department of Ophthalmology, Eye and Ear Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - K. Bailey Freund
- Vitreous Retina Macular Consultants of New York, New York, New York
- LuEsther T. Merz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York
| | - Ethan A. Rossi
- Department of Ophthalmology, Eye and Ear Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kunal K. Dansingani
- Department of Ophthalmology, Eye and Ear Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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6
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Koretz ZA, Apostolopoulou A, Chen E, Beale O, Veldkamp P, Viehman JA, Sahel JA, Chhablani J, Dansingani KK, Errera MH, Bonhomme GR. Clinical Features and Multimodal Imaging in Atypical Posterior Uveitis Secondary to Bartonella Henselae Infection. Ocul Immunol Inflamm 2022; 30:2047-2054. [PMID: 34402723 DOI: 10.1080/09273948.2021.1961812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To characterize an unusual presentation of infectious posterior uveitis using multimodal imaging, and discuss the clinical decision-making involved in diagnosis and treatment. METHODS Wide-field fundus photography, swept-source optical coherence tomography (OCT), swept-source OCT angiography, fluorescein angiography, and indocyanine green angiography. RESULTS This patient presented with cyclical fevers and blurry vision. Fundus examination revealed bilateral optic disc edema, macular intraretinal white spots and many scattered yellow-white chorioretinal lesions. Multimodal imaging characteristics suggested that many of these lesions represent choroidal granulomas. Extensive systemic workup was only notable for borderline elevated Bartonella henselae IgG titers (1:128), however convalescent IgG titers were elevated at 38 days (1:512) supporting the diagnosis of Bartonella chorioretinitis. CONCLUSION Ocular manifestations of Bartonella henselae infection are varied and may include choroidal granulomas. Multimodal imaging characteristics may help identify etiologies of infectious uveitis. Convalescent titers are important when evaluating patients with suspected Bartonellosis, especially patients with atypical presentations.
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Affiliation(s)
- Zachary A Koretz
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Anna Apostolopoulou
- Division of General Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Edwin Chen
- Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Oliver Beale
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Peter Veldkamp
- Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - John Alex Viehman
- Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - José-Alain Sahel
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kunal K Dansingani
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Marie-Hélène Errera
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Gabrielle R Bonhomme
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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7
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Vienola KV, Zhang M, Snyder VC, Dansingani KK, Sahel JA, Rossi EA. Near infrared autofluorescence imaging of retinal pigmented epithelial cells using 663 nm excitation. Eye (Lond) 2022; 36:1878-1883. [PMID: 34462582 PMCID: PMC9499940 DOI: 10.1038/s41433-021-01754-0] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 08/03/2021] [Accepted: 08/18/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Fundus autofluorescence (AF) using adaptive optics scanning laser ophthalmoscopy (AOSLO) enables morphometric analysis of individual retinal pigmented epithelial (RPE) cells. However, only a few excitation wavelengths in the visible and near-infrared have been evaluated. Visible light excitation (<600 nm) presents additional safety hazards and is uncomfortable for patients. Near-infrared excitation (>700 nm) overcomes those problems but introduces others, including decreased AF signal and cone signatures that obscure RPE structure. Here we investigated the use of an intermediate wavelength, 663 nm, for excitation and compared it to 795 nm. METHODS Subjects were imaged using AOSLO equipped with a detection channel to collect AF emission between 814 and 850 nm. Two light sources (663 and 795 nm) were used to excite the retinal fluorophores. We recorded 90 s videos and registered them with custom software to integrate AF images for analysis. RESULTS We imaged healthy eyes and an eye with pattern dystrophy. Similar AF microstructures were detected with each excitation source, despite ~4 times lower excitation power with 663 nm. The signal-to-noise values showed no meaningful difference between 663 nm and 795 nm excitation and a similar trend was observed for image contrast between the two excitation wavelengths. CONCLUSIONS Lower light levels can be used with shorter wavelength excitation to achieve comparable images of the microstructure of the RPE as have been obtained using higher light levels at longer wavelengths. Further experiments are needed to fully characterize AF across spectrum and determine the optimal excitation and emission bandwidths that balance efficiency, patient comfort, and efficacy.
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Affiliation(s)
- Kari V Vienola
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- Department of Ophthalmology and Vision Science, University of California Davis, Sacramento, CA, USA.
| | - Min Zhang
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Valerie C Snyder
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kunal K Dansingani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - José-Alain Sahel
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ethan A Rossi
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, PA, USA
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Beeche C, Singh JP, Leader JK, Gezer S, Oruwari AP, Dansingani KK, Chhablani J, Pu J. Super U-Net: a modularized generalizable architecture. Pattern Recognit 2022; 128:108669. [PMID: 35528144 PMCID: PMC9070860 DOI: 10.1016/j.patcog.2022.108669] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To develop and validate a novel convolutional neural network (CNN) termed "Super U-Net" for medical image segmentation. METHODS Super U-Net integrates a dynamic receptive field module and a fusion upsampling module into the classical U-Net architecture. The model was developed and tested to segment retinal vessels, gastrointestinal (GI) polyps, skin lesions on several image types (i.e., fundus images, endoscopic images, dermoscopic images). We also trained and tested the traditional U-Net architecture, seven U-Net variants, and two non-U-Net segmentation architectures. K-fold cross-validation was used to evaluate performance. The performance metrics included Dice similarity coefficient (DSC), accuracy, positive predictive value (PPV), and sensitivity. RESULTS Super U-Net achieved average DSCs of 0.808±0.0210, 0.752±0.019, 0.804±0.239, and 0.877±0.135 for segmenting retinal vessels, pediatric retinal vessels, GI polyps, and skin lesions, respectively. The Super U-net consistently outperformed U-Net, seven U-Net variants, and two non-U-Net segmentation architectures (p < 0.05). CONCLUSION Dynamic receptive fields and fusion upsampling can significantly improve image segmentation performance.
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Affiliation(s)
- Cameron Beeche
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Jatin P Singh
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Joseph K Leader
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Sinem Gezer
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Amechi P Oruwari
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Kunal K Dansingani
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Jiantao Pu
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA 15213, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, USA
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9
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Vienola KV, Dansingani KK, Eller AW, Martel JN, Snyder VC, Rossi EA. Multimodal Imaging of Torpedo Maculopathy With Fluorescence Adaptive Optics Imaging of Individual Retinal Pigmented Epithelial Cells. Front Med (Lausanne) 2021; 8:769308. [PMID: 34957148 PMCID: PMC8698897 DOI: 10.3389/fmed.2021.769308] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 11/08/2021] [Indexed: 12/03/2022] Open
Abstract
Torpedo maculopathy (TM) is a rare congenital defect of the retinal pigment epithelium (RPE). The RPE is often evaluated clinically using fundus autofluorescence (AF), a technique that visualizes RPE structure at the tissue level from the intrinsic AF of RPE fluorophores. TM lesions typically emit little or no AF, but this macroscopic assessment is unable to resolve the RPE cells, leaving the organization of the RPE cell mosaic in TM unknown. We used fluorescence adaptive optics scanning laser ophthalmoscopy (AOSLO) to show here for the first time the microscopic cellular-level structural alterations to the RPE cell mosaic in TM that underlie the tissue-level changes seen in conventional clinical imaging. We evaluated two patients with TM using conventional clinical imaging techniques and adaptive optics (AO) infrared autofluorescence (IRAF) in AOSLO. Confocal AOSLO revealed relatively normal cones outside the TM lesion but altered cone appearance within it and along its margins in both patients. We quantified cone topography and RPE cell morphometry from the fovea to the margin of the lesion in case 1 and found cone density to be within the normal range across the locations imaged. However, RPE morphometric analysis revealed disrupted RPE cells outside the margin of the lesion; the mean RPE cell area was greater than two standard deviations above the normative range up to approximately 1.5 mm from the lesion margin. Similar morphometric changes were seen to individual RPE cells in case 2. Multi-modal imaging with AOSLO reveals that RPE cells are abnormal in TM well beyond the margins of the characteristic TM lesion boundary defined with conventional clinical imaging. Since the TM fovea appears to be fully formed, with normal cone packing, it is possible that the congenital RPE defect in TM occurs relatively late in retinal development. This work demonstrates how cellular level imaging of the RPE can provide new insight into RPE pathologies, particularly for rare conditions such as TM.
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Affiliation(s)
- Kari V Vienola
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Kunal K Dansingani
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Andrew W Eller
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Joseph N Martel
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Valerie C Snyder
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Ethan A Rossi
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, PA, United States.,McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, United States
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10
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Rossi EA, Norberg N, Eandi C, Chaumette C, Kapoor S, Le L, Snyder VC, Martel JN, Gautier J, Gocho K, Dansingani KK, Chhablani J, Arleo A, Mrejen S, Sahel JA, Grieve K, Paques M. A New Method for Visualizing Drusen and Their Progression in Flood-Illumination Adaptive Optics Ophthalmoscopy. Transl Vis Sci Technol 2021; 10:19. [PMID: 34928325 PMCID: PMC8709936 DOI: 10.1167/tvst.10.14.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Drusen are dynamic sub-RPE deposits that are risk factors for late-stage age-related macular degeneration (AMD). Here we show a new imaging method using flood-illumination adaptive optics (FIAO) that reveal drusen with high contrast and resolution. Methods A fovea-centered 4° × 4° FIAO image and eight surrounding images with gaze displaced by ±2° vertically and horizontally were acquired. Clinical color fundus and spectral-domain optical coherence tomography were acquired for clinical grading and comparison. Custom software registered overlapping FIAO images and fused the data statistically to generate a fovea-centered 4° × 4° gaze-dependent image. Our dataset included 15 controls (aged 31-72) and 182 eyes from 104 AMD patients (aged 56-92), graded as either normal aging (n = 7), and early (n = 12), intermediate (n = 108) and late AMD (n = 42); 27 had subretinal drusenoid deposits (SDDs), and 83 were imaged longitudinally. Results No gaze varying structures were detected in young eyes. In aging eyes with no evidence of age-related changes, putative drusen <20 µm in diameter were visible. Gaze-dependent images revealed more drusen and many smaller drusen than visible in color fundus images. Longitudinal images showed expansion and fusion of drusen. SDDs were lower contrast, and RPE atrophy did not yield a consistent signal. Conclusions Gaze-dependent imaging in a commercially available FIAO fundus camera combined with image registration and postprocessing permits visualization of drusen and their progression with high contrast and resolution. Translational Relevance This new technique offers promise as a robust and sensitive method to detect, map, quantify, and monitor the dynamics of drusen in aging and AMD.
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Affiliation(s)
- Ethan A Rossi
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, PA, USA.,McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nathaniel Norberg
- Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17 rue Moreau, F-75012 Paris, France and CHNO des Quinze-Vingts, INSERM-DGOS CIC 1423, 28 rue de Charenton, F-75012 Paris, France
| | - Chiara Eandi
- Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17 rue Moreau, F-75012 Paris, France and CHNO des Quinze-Vingts, INSERM-DGOS CIC 1423, 28 rue de Charenton, F-75012 Paris, France.,Department of Surgical Science, University of Torino, Turin, Italy
| | - Celine Chaumette
- Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17 rue Moreau, F-75012 Paris, France and CHNO des Quinze-Vingts, INSERM-DGOS CIC 1423, 28 rue de Charenton, F-75012 Paris, France
| | - Saloni Kapoor
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Laura Le
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Valerie C Snyder
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Joseph N Martel
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Josselin Gautier
- Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17 rue Moreau, F-75012 Paris, France and CHNO des Quinze-Vingts, INSERM-DGOS CIC 1423, 28 rue de Charenton, F-75012 Paris, France
| | - Kiyoko Gocho
- Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17 rue Moreau, F-75012 Paris, France and CHNO des Quinze-Vingts, INSERM-DGOS CIC 1423, 28 rue de Charenton, F-75012 Paris, France
| | - Kunal K Dansingani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Angelo Arleo
- Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17 rue Moreau, F-75012 Paris, France and CHNO des Quinze-Vingts, INSERM-DGOS CIC 1423, 28 rue de Charenton, F-75012 Paris, France
| | - Sarah Mrejen
- Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17 rue Moreau, F-75012 Paris, France and CHNO des Quinze-Vingts, INSERM-DGOS CIC 1423, 28 rue de Charenton, F-75012 Paris, France
| | - José-Alain Sahel
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17 rue Moreau, F-75012 Paris, France and CHNO des Quinze-Vingts, INSERM-DGOS CIC 1423, 28 rue de Charenton, F-75012 Paris, France
| | - Kate Grieve
- Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17 rue Moreau, F-75012 Paris, France and CHNO des Quinze-Vingts, INSERM-DGOS CIC 1423, 28 rue de Charenton, F-75012 Paris, France
| | - Michel Paques
- Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17 rue Moreau, F-75012 Paris, France and CHNO des Quinze-Vingts, INSERM-DGOS CIC 1423, 28 rue de Charenton, F-75012 Paris, France
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11
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Lejoyeux R, Benillouche J, Ong J, Errera MH, Rossi EA, Singh SR, Dansingani KK, da Silva S, Sinha D, Sahel JA, Freund KB, Sadda SR, Lutty GA, Chhablani J. Choriocapillaris: Fundamentals and advancements. Prog Retin Eye Res 2021; 87:100997. [PMID: 34293477 DOI: 10.1016/j.preteyeres.2021.100997] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [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: 04/02/2021] [Revised: 07/02/2021] [Accepted: 07/13/2021] [Indexed: 12/19/2022]
Abstract
The choriocapillaris is the innermost structure of the choroid that directly nourishes the retinal pigment epithelium and photoreceptors. This article provides an overview of its hemovasculogenesis development to achieve its final architecture as a lobular vasculature, and also summarizes the current histological and molecular knowledge about choriocapillaris and its dysfunction. After describing the existing state-of-the-art tools to image the choriocapillaris, we report the findings in the choriocapillaris encountered in the most frequent retinochoroidal diseases including vascular diseases, inflammatory diseases, myopia, pachychoroid disease spectrum disorders, and glaucoma. The final section focuses on the development of imaging technology to optimize visualization of the choriocapillaris as well as current treatments of retinochoroidal disorders that specifically target the choriocapillaris. We conclude the article with pertinent unanswered questions and future directions in research for the choriocapillaris.
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Affiliation(s)
| | | | - Joshua Ong
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Marie-Hélène Errera
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Ethan A Rossi
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; Department of Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, PA 15213, USA
| | - Sumit R Singh
- Jacobs Retina Center, Shiley Eye Institute, University of California San Diego, San Diego, CA, USA
| | - Kunal K Dansingani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Susana da Silva
- Department of Ophthalmology and Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Debasish Sinha
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; Department of Cell Biology and Center for Biologic Imaging, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - José-Alain Sahel
- Rothschild Foundation, 75019, Paris, France; Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; Sorbonne Université, INSERM, CNRS, Institut de la Vision, Paris, France; CHNO des Quinze-Vingts, INSERM-DGOS CIC 1423, Paris, France
| | - K Bailey Freund
- LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, NY, USA; Vitreous Retina Macula Consultants of New York, New York, NY, USA; Department of Ophthalmology, New York University of Medicine, New York, NY, USA; Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY, USA
| | - SriniVas R Sadda
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, CA, 90033, USA; Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Gerard A Lutty
- Wilmer Ophthalmological Institute, Johns Hopkins Hospital, Baltimore, MD, 21287, USA
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
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12
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Torregrossa G, Torregrossa S, Dansingani KK, De Salvo G. Vitreomacular traction spontaneous resolution after pharmacological mydriasis. Clin Exp Optom 2021; 104:876-878. [PMID: 33730523 DOI: 10.1080/08164622.2021.1896943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Giulia Torregrossa
- Department of Ophthalmology, Fatebenefratelli Oftalmico Hospital, Milan, Italy
| | | | - Kunal K Dansingani
- UPMC Eye Center, Eye & Ear Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gabriella De Salvo
- Department of Ophthalmology, University Hospital Southampton, Southampton, UK
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13
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Mebsout-Pallado C, Orès R, Terrada C, Dansingani KK, Chhablani J, Eller AW, Martel JN, Anetakis A, Harwick JC, Waxman EL, Gallagher DS, Prensky C, Indermill C, Sedira N, Héron E, Paques M, Brignole-Baudouin F, Bodaghi B, Sahel JA, Gaudric A, Mrejen S, Errera MH. Review of the Current Literature and Our Experience on the Value of OCT-angiography in White Dot Syndromes. Ocul Immunol Inflamm 2021; 30:364-378. [PMID: 33617412 DOI: 10.1080/09273948.2020.1837185] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To describe the application of OCT-A in various posterior uveitis disorders in our experience and to compare it with the available literature. METHODS Eighteen eyes with the diagnoses of multifocal choroiditis (MFC), multifocal placoid pigment epitheliopathy (APMPPE), multiple evanescent white dot syndrome (MEWDS), tuberculous serpiginous-like choroiditis (SLC), serpiginous choroiditis (SC), and birdshot chorioretinopathy (BSCR) were studied. RESULTS We found flow void of the choriocapillaris in patients with APMPPE, SC, MFC, BSCR, and in SLC. In contrast, perfusion of the choriocapillaris seemed normal in patients with MEWDS. CONCLUSIONS We confirmed that OCT-A contributes new information on the physiopathology of white dot syndromes and inflammatory chorioretinopathies, notably on whether or not the choriocapillaris is involved. Comparing the OCT-A features allowed us to suggest that both APMPPE and SLC might be part of the same spectrum of inflammatory disease with primary involvement at the level of the choriocapillaris and secondary RPE damage.
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Affiliation(s)
| | - Raphaëlle Orès
- DHU Sight Restore, Centre Hospitalier National Des Quinze-Vingts, Paris, France
| | - Céline Terrada
- Department of Ophthalmology, Lariboisière Hospital, Université Paris Diderot, Paris, France.,Centre Ophtalmologique Roule Peretti, Neuilly Sur Seine, France
| | - Kunal K Dansingani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Andrew W Eller
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Joseph N Martel
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Alexander Anetakis
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jean C Harwick
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Evan L Waxman
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Denise S Gallagher
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Colin Prensky
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Chad Indermill
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Neila Sedira
- DHU Sight Restore, Centre Hospitalier National Des Quinze-Vingts, Paris, France
| | - Emmanuel Héron
- DHU Sight Restore, Centre Hospitalier National Des Quinze-Vingts, Paris, France
| | - Michel Paques
- DHU Sight Restore, Centre Hospitalier National Des Quinze-Vingts, Paris, France.,INSERM-DHOS CIC, Sorbonne Universités, France
| | - Françoise Brignole-Baudouin
- DHU Sight Restore, Centre Hospitalier National Des Quinze-Vingts, Paris, France.,Université Paris Descartes (Sorbonne Paris Cité), Paris V, France
| | - Bahram Bodaghi
- Department of Ophthalmology, Hopital Pitié-Salpêtrière, DHU Sight Restore, Sorbonne Universités, Paris, France
| | - José-Alain Sahel
- DHU Sight Restore, Centre Hospitalier National Des Quinze-Vingts, Paris, France.,Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,INSERM-DHOS CIC, Sorbonne Universités, France
| | - Alain Gaudric
- Department of Ophthalmology, Lariboisière Hospital, Université Paris Diderot, Paris, France
| | - Sarah Mrejen
- DHU Sight Restore, Centre Hospitalier National Des Quinze-Vingts, Paris, France
| | - Marie-Hélène Errera
- DHU Sight Restore, Centre Hospitalier National Des Quinze-Vingts, Paris, France.,Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,INSERM-DHOS CIC, Sorbonne Universités, France
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14
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Williams AM, Kalra G, Commiskey PW, Bowers EMR, Rudolph BR, Pitcher MD, Dansingani KK, Jhanji V, Nischal KK, Sahel JA, Waxman EL, Fu R. Ophthalmology Practice During the Coronavirus Disease 2019 Pandemic: The University of Pittsburgh Experience in Promoting Clinic Safety and Embracing Video Visits. Ophthalmol Ther 2020; 9:1-9. [PMID: 32377502 PMCID: PMC7201393 DOI: 10.1007/s40123-020-00255-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Indexed: 01/08/2023] Open
Abstract
The coronavirus disease 2019 pandemic has led to widespread change as public health strategies for containment have emphasized social distancing and remaining at home. These policies have led to downscaled clinic volumes, cancellation of elective procedures, enhanced personal protective strategies in the clinic, and adoption of telemedicine encounters. We describe the evidence-based practical approach taken in our ophthalmology department to continue delivering eye care during the pandemic by rescheduling visits, enhancing clinic safety, and adopting virtual video encounters.
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Affiliation(s)
- Andrew M. Williams
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Gagan Kalra
- Government Medical College and Hospital, Chandigarh, India
| | - Patrick W. Commiskey
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Eve M. R. Bowers
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Brian R. Rudolph
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Mary D. Pitcher
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Kunal K. Dansingani
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Ken K. Nischal
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - José-Alain Sahel
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Evan L. Waxman
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Roxana Fu
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA USA
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15
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Vienola KV, Zhang M, Snyder VC, Sahel JA, Dansingani KK, Rossi EA. Microstructure of the retinal pigment epithelium near-infrared autofluorescence in healthy young eyes and in patients with AMD. Sci Rep 2020; 10:9561. [PMID: 32533046 PMCID: PMC7293312 DOI: 10.1038/s41598-020-66581-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 05/21/2020] [Indexed: 01/18/2023] Open
Abstract
Retinal pigmented epithelial (RPE) cells are essential for maintaining normal visual function, especially in their role in the visual cycle, and are thought to be one of the first cell classes affected by age-related macular degeneration (AMD). Clinical imaging systems routinely evaluate the structure of the RPE at the tissue level, but cellular level information may provide valuable RPE biomarkers of health, aging and disease. In this exploratory study, participants were imaged with 795 nm excitation in adaptive optics scanning laser ophthalmoscopy (AOSLO) to observe the microstructure of the near-infrared autofluorescence (AO-IRAF) from the RPE layer in healthy retinas and patients with AMD. The expected hexagonal mosaic of RPE cells was only sometimes seen in normal eyes, while AMD patients exhibited highly variable patterns of altered AO-IRAF. In some participants, AO-IRAF structure corresponding to cones was observed, as we have demonstrated previously. In some AMD patients, marked alterations in the pattern of AO-IRAF could be seen even in areas where the RPE appeared relatively normal in clinical imaging modalities, such as spectral domain optical coherence tomography (SD-OCT). AO-IRAF imaging using AOSLO offers promise for better detection and understanding of early RPE changes in the course of AMD, potentially before clinical signs appear.
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Affiliation(s)
- Kari V Vienola
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA.
| | - Min Zhang
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Valerie C Snyder
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - José-Alain Sahel
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Kunal K Dansingani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Ethan A Rossi
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
- Department of Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, PA, 15213, USA
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16
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Usmani B, Latif A, Iftikhar M, Sepah YJ, Parker C, Fliss JA, Dansingani KK, Shah SMA. Eye trauma in falls presenting to the emergency department from 2006 through 2015. Br J Ophthalmol 2020; 105:198-204. [DOI: 10.1136/bjophthalmol-2019-314669] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 03/22/2020] [Accepted: 03/31/2020] [Indexed: 11/04/2022]
Abstract
AimsTo characterise the epidemiology of eye trauma in the event of falls presenting to the emergency departments (ED) in the USA.MethodRetrospective cohort study. Nationwide Emergency Department Sample was used to analyse fall encounters presenting to the ED with eye trauma from 2006 to 2015. National estimates of the leading diagnoses were determined, and multivariable regression was used to determine the relationship between factors involved in fall encounters presenting with eye trauma.ResultsFrom 2006 to 2015, an estimated 87 991 036 fall encounters presented to the ED, of which 952 781 encounters had eye trauma as either a primary or secondary diagnosis. The overall incidence of fall encounters with eye trauma per 100 000 US population increased from 30.7 encounters in 2006 to 33.8 encounters per 100 000 population in 2014 with a decrease seen in 2015. Eye trauma, including vision-threatening type, was highest in females (n=500 520, 52.5%), elderly (n=400 209, 42%) and children (n=2 06 741, 21.7%). Elderly were more likely to have eye trauma in the setting of falls (adjusted OR (aOR) 2.06, 95% CI 2.02 to 2.11) and be admitted (aOR 1.89, 95% CI 1.86 to 1.91) than adults (reference). The leading types of eye trauma were contusion of orbital tissues (n=174 292, 18.3%), laceration of eyelid and periocular area (n=172 361, 18.1%) and orbital fractures (n=151 013, 15.8%).ConclusionsFalls are preventable, yet the incidence of falls and resulting eye trauma are increasing despite our best efforts. As ophthalmologists, we should not only develop guidelines to recognise and counsel at-risk groups under our care but also strategies for prevention of eye trauma secondary to falls.
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17
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Usmani B, Latif A, Amarasekera S, Mukhtar S, Iftikhar M, Kherani S, Sepah YJ, Raghavan D, Smith WD, Jhanji V, Dansingani KK, Shah SMA. Eye-Related Emergency Department Visits and The Opioid Epidemic: a 10-Year Analysis. Ophthalmic Epidemiol 2020; 27:300-309. [PMID: 32223491 DOI: 10.1080/09286586.2020.1744165] [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] [Indexed: 10/24/2022]
Abstract
PURPOSE To describe the epidemiology of Emergency Department (ED) visits related to opioid abuse with primary ophthalmic diagnoses in the United States (US). METHODS This retrospective cross-sectional study used National ED Sample (NEDS) (2006-2015), a representative sample of all US EDs, to analyze and compare the epidemiology of primary ophthalmic diagnoses in opioid abusers and a control group of non-opioid users. National incidence and descriptive statistics were calculated for demographics and prevalent diagnoses. Multivariable logistic regression was used to compare outcomes between primary ophthalmic diagnoses in opioid and non-opioid abusers. RESULTS An estimated 10,617 visits had a primary ophthalmic diagnosis and an accompanying opioid abuse diagnosis, and the incidence increased from 0.2 in 2006 to 0.6 per 100,000 US population in 2015. Opioid abuse group had more adults (6,747:63.5%) and middle-aged (3,361:31.7%) patients, while in controls adults (7,905,003:40.4%) and children (4,068,534:20.8%) were affected more. Leading etiologies were similar: traumatic and infectious etiologies were most common; however, opioid abuse patients had more severe ophthalmic diagnoses such as orbital fractures (8.4%), orbital cellulitis (7.4%), globe injury (3.4%) and endophthalmitis (3.2%) compared to controls. Patients in the opioid abuse group were also more likely to be admitted (adjusted Odds Ratio [aOR], 28.38 [95% CI, 24.50-32.87]). CONCLUSIONS In the era of opioid crisis, an increase in ED visits with ophthalmic complaints is seen, with increasing direct and indirect costs on the healthcare system. More research is needed to establish causality and devise strategies to lower this burden.
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Affiliation(s)
- Bushra Usmani
- Department of Ophthalmology, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania, USA
| | - Asad Latif
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine , Baltimore, Maryland, USA
| | - Sohani Amarasekera
- Department of Ophthalmology, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania, USA
| | - Sabrina Mukhtar
- Department of Ophthalmology, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania, USA
| | - Mustafa Iftikhar
- Wilmer Eye Institute, Johns Hopkins University School of Medicine , Baltimore, Maryland, USA
| | - Saleema Kherani
- Wilmer Eye Institute, Johns Hopkins University School of Medicine , Baltimore, Maryland, USA
| | - Yasir J Sepah
- Byers Eye Institute, Stanford University , Palo Alto, California, USA
| | - Deepta Raghavan
- Department of Ophthalmology, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania, USA
| | - William D Smith
- Department of Ophthalmology, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania, USA
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania, USA
| | - Kunal K Dansingani
- Department of Ophthalmology, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania, USA
| | - Syed M A Shah
- Department of Ophthalmology, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania, USA
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18
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Teja RV, Reddy Manne S, Goud A, Rasheed MA, Dansingani KK, Chhablani J, Vupparaboina KK, Jana S. Classification and Quantification of Retinal Cysts in OCT B-Scans: Efficacy of Machine Learning Methods. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2019:48-51. [PMID: 31945842 DOI: 10.1109/embc.2019.8857075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The automatic segmentation of fluid spaces in optical coherence tomography (OCT) imaging facilitates clinically relevant quantification and monitoring of eye disorders over time. Eyes with florid disease are particularly challenging to segment, as the anatomy is often highly distorted from normal. In this context, we propose an end-to-end machine learning method consisting of near perfect detection of retinal fluid using random forest classifier and an efficient DeepLab algorithm for quantification and labeling of the target fluid compartments. In particular, we achieve an average Dice score of 86.23% with reference to manual delineations made by a trained expert.
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19
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Freund KB, Sarraf D, Leong BCS, Garrity ST, Vupparaboina KK, Dansingani KK. Association of Optical Coherence Tomography Angiography of Collaterals in Retinal Vein Occlusion With Major Venous Outflow Through the Deep Vascular Complex. JAMA Ophthalmol 2019; 136:1262-1270. [PMID: 30352115 DOI: 10.1001/jamaophthalmol.2018.3586] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Analysis of collateral vessel formation following retinal vein occlusion may advance our understanding of the venous outflow anatomy in the macula. Objective To determine the location of collateral vessels with optical coherence tomography (OCT) angiography imaging. Design, Setting, and Participants Observational retrospective cohort study. Collateral vessel formation was studied with OCT angiography (OCTA) in patients with retinal vein occlusion (RVO). The study took place at 2 retinal practices (Vitreous Retina Macula Consultants of New York and Stein Eye Institute, University of California, Los Angeles), with patient records retrieved from March 2015 to August 2017. Data analysis was completed in November 2017. Exposures Collaterals identified with fundus photography and/or fluorescein angiography were analyzed with OCTA to determine their course through the superficial vascular plexus (SVP) and the deep vascular complex (DVC). Main Outcomes and Measures Collateral vessel pathways through the SVP and DVC were analyzed with cross-sectional and en face OCT and OCTA segmentation and color-coded volume renderings prepared from raw OCTA voxel data. Results From 23 eyes (22 branch and 1 hemispheric retinal vein occlusion ) of 23 patients (mean [SD] age, 73 [11] years), 101 collateral vessels were identified and analyzed (mean [SD], 4.4 [2.0]; range, 2-9 collateral per eye). On OCTA, the collaterals appeared as curvilinear dilated flow signals that connected veins across the horizontal raphe or veins on opposite sides of an occluded venous segment within the same retinal hemisphere. Of the 101 collaterals analyzed, all showed greater flow signal in the DVC, and all had some portion of their course identified within the DVC. No collaterals were found exclusively in the SVP. Volume renderings for 3 cases confirmed qualitatively that retinal collateral vessels course through the retina predominantly at the level of the DVC. Conclusions and Relevance Based on a limited number of cases, all collateral vessels associated with retinal vein occlusion were found to course through the DVC. The absence of collaterals isolated to the SVP supports a serial arrangement of the SVP and DVC, with venous drainage predominantly coursing through the DVC.
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Affiliation(s)
- K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York.,Department of Ophthalmology, New York University School of Medicine, New York
| | - David Sarraf
- Stein Eye Institute, David Geffen School of Medicine at University of California, Los Angeles.,Greater Los Angeles VA Healthcare Center, Los Angeles, California
| | | | - Sean Thomas Garrity
- Stein Eye Institute, David Geffen School of Medicine at University of California, Los Angeles
| | - Kiran K Vupparaboina
- Surjana Center for Innovation, LV Prasad Eye Institute, Hyderabad, India.,Department of Electrical Engineering, Indian Institute of Technology, Hyderabad, India
| | - Kunal K Dansingani
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Moorfields Eye Hospital, London, England
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20
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Singh SR, Vupparaboina KK, Goud A, Dansingani KK, Chhablani J. Choroidal imaging biomarkers. Surv Ophthalmol 2018; 64:312-333. [PMID: 30496750 DOI: 10.1016/j.survophthal.2018.11.002] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [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: 05/18/2018] [Revised: 11/18/2018] [Accepted: 11/19/2018] [Indexed: 12/22/2022]
Abstract
The choroid is the vascular coat of the eye, and its role has been studied in multiple chorioretinal disorders. Recent advancements in choroidal imaging techniques, including enhanced depth imaging optical coherence tomography, swept source optical coherence tomography, en face optical coherence tomography, and optical coherence tomography angiography have facilitated an in-depth analysis of the choroid. The gradual shift from manual to automated segmentation and binarization methods have led to precise and reproducible measurements of choroidal parameters. These qualitative and quantitative parameters, called choroidal imaging biomarkers, have evolved over the past decade from a simple linear subfoveal choroidal thickness to more complex 3D choroidal reconstruction, thus widening the spectrum encompassing multiple parameters. These biomarkers have provided a better understanding of the pathogenesis, are helpful in diagnostic dilemmas, and, in the future may also help to devise treatment options. The lack of normative data, absence of standardized parameters, and limitations of the imaging techniques, however, have led to ambiguity and difficulty in the interpretation of these variables. We attempt to address these lacunae in the literature and provide a basic understanding of the choroid in both health and disease using these choroidal biomarkers.
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Affiliation(s)
- Sumit Randhir Singh
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, LV Prasad Eye Institute, Hyderabad, India; Retina and Uveitis Department, GMR Varalakshmi Campus, LV Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
| | - Kiran Kumar Vupparaboina
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, LV Prasad Eye Institute, Hyderabad, India
| | - Abhilash Goud
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, LV Prasad Eye Institute, Hyderabad, India
| | - Kunal K Dansingani
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jay Chhablani
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, LV Prasad Eye Institute, Hyderabad, India.
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21
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Lee J, Scanga HL, Dansingani KK, Taubenslag KJ, Zlotcavitch L, Chauhan BK, Sylvester CL, Morton DH, Nischal KK. Clinical and imaging characteristics of posterior column ataxia with retinitis pigmentosa with a specific FLVCR1 mutation. Ophthalmic Genet 2018; 39:735-740. [DOI: 10.1080/13816810.2018.1547913] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Jennifer Lee
- Department of Pediatric Ophthalmology, Strabismus, and Adult Motility, Children’s Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Hannah L. Scanga
- Department of Pediatric Ophthalmology, Strabismus, and Adult Motility, Children’s Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kunal K. Dansingani
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kenneth J. Taubenslag
- Department of Pediatric Ophthalmology, Strabismus, and Adult Motility, Children’s Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Leonid Zlotcavitch
- Department of Pediatric Ophthalmology, Strabismus, and Adult Motility, Children’s Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Bharesh K. Chauhan
- Department of Pediatric Ophthalmology, Strabismus, and Adult Motility, Children’s Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Christin L. Sylvester
- Department of Pediatric Ophthalmology, Strabismus, and Adult Motility, Children’s Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - D. Holmes Morton
- Pediatrician, Central Pennsylvania Clinic for Special Children and Adults, Belleville, Pennsylvania, USA
- Department of Pediatrics, Children’s Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ken K. Nischal
- Department of Pediatric Ophthalmology, Strabismus, and Adult Motility, Children’s Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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22
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Naysan J, Dansingani KK, Balaratnasingam C, Mrejen S, Levasseur S, Merkur A, Yannuzzi LA. CRYSTALLINE RETINOPATHY AND RETINAL VASCULOPATHY IN CALCIFIC UREMIC ARTERIOLOPATHY (CALCIPHYLAXIS). Retin Cases Brief Rep 2018; 12:331-335. [PMID: 30226832 DOI: 10.1097/icb.0000000000000494] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE To report the posterior segment and retinal vascular manifestations of calcific uremic arteriolopathy (calciphylaxis). Clinical findings are correlated with multimodal imaging results. METHODS Observational case report. RESULTS A 65-year-old white woman on hemodialysis was referred for assessment of poor vision bilaterally. Clinical examination demonstrated a crystalline retinopathy with stigma of previous retinal arterial occlusion. Fluorescein angiography revealed delayed retinal arterial filling bilaterally, sheathing of vessels, and peripheral nonperfusion. The crystals were hyperautofluorescent. Spectral domain and enhanced depth imaging optical coherence tomography localized the crystals within the retina with a predilection for the retinal arterial vasculature. The choriocapillaris was not involved. Two years prior, the patient developed necrotic skin lesions which were biopsied and confirmed the diagnosis of calciphylaxis. CONCLUSION Calcific uremic arteriolopathy is an extremely rare cause of thrombogenic microangiopathy in end-stage renal disease patients. Retinal arterial occlusion appears to be a rare but significant cause of visual loss in this disease and is likely to be consequent to crystalline deposition in the retinal vasculature.
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Affiliation(s)
- Jonathan Naysan
- Vitreous Retina Macula Consultants of New York, New York
- LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York
- Department of Ophthalmology, New York University School of Medicine, New York, New York
- Department of Ophthalmology, North-Shore Long Island Jewish Health System, Manhasset, New York
| | - Kunal K Dansingani
- Vitreous Retina Macula Consultants of New York, New York
- LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York
| | - Chandrakumar Balaratnasingam
- Vitreous Retina Macula Consultants of New York, New York
- LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York
| | - Sarah Mrejen
- Vitreous Retina Macula Consultants of New York, New York
- LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York
| | - Steven Levasseur
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew Merkur
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lawrence A Yannuzzi
- Vitreous Retina Macula Consultants of New York, New York
- LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York
- Department of Ophthalmology, New York University School of Medicine, New York, New York
- Department of Ophthalmology, North-Shore Long Island Jewish Health System, Manhasset, New York
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23
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Dansingani KK, Vupparaboina KK, Devarkonda ST, Jana S, Chhablani J, Freund KB. Amplitude-scan classification using artificial neural networks. Sci Rep 2018; 8:12451. [PMID: 30127536 PMCID: PMC6102218 DOI: 10.1038/s41598-018-31021-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 08/09/2018] [Indexed: 12/03/2022] Open
Abstract
Optical coherence tomography (OCT) images semi-transparent tissues noninvasively. Relying on backscatter and interferometry to calculate spatial relationships, OCT shares similarities with other pulse-echo modalities. There is considerable interest in using machine learning techniques for automated image classification, particularly among ophthalmologists who rely heavily on diagnostic OCT. Artificial neural networks (ANN) consist of interconnected nodes and can be employed as classifiers after training on large datasets. Conventionally, OCT scans are rendered as 2D or 3D human-readable images of which the smallest depth-resolved unit is the amplitude-scan reflectivity-function profile which is difficult for humans to interpret. We set out to determine whether amplitude-scan reflectivity-function profiles representing disease signatures could be distinguished and classified by a feed-forward ANN. Our classifier achieved high accuracies after training on only 24 eyes, with evidence of good generalization on unseen data. The repertoire of our classifier can now be expanded to include rare and unseen diseases and can be extended to other disciplines and industries.
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Affiliation(s)
- Kunal K Dansingani
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Kiran Kumar Vupparaboina
- L.V. Prasad Eye Institute, Hyderabad, Telangana, India
- Department of Electrical Engineering, Indian Institute of Technology Hyderabad, Hyderabad, Telangana, India
| | - Surya Teja Devarkonda
- Department of Electrical Engineering, Indian Institute of Technology Hyderabad, Hyderabad, Telangana, India
| | - Soumya Jana
- Department of Electrical Engineering, Indian Institute of Technology Hyderabad, Hyderabad, Telangana, India
| | - Jay Chhablani
- L.V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, NY, USA
- LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, NY, USA
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24
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Savastano MC, Dansingani KK, Rispoli M, Virgili G, Savastano A, Freund KB, Lumbroso B. CLASSIFICATION OF HALLER VESSEL ARRANGEMENTS IN ACUTE AND CHRONIC CENTRAL SEROUS CHORIORETINOPATHY IMAGED WITH EN FACE OPTICAL COHERENCE TOMOGRAPHY. Retina 2018; 38:1211-1215. [PMID: 28489695 DOI: 10.1097/iae.0000000000001678] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the prevailing patterns of Haller vessel arrangements at the posterior pole between healthy eyes and those with central serous chorioretinopathy (CSC) using en face optical coherence tomography. METHODS Eyes of normal subjects and patients with acute or chronic CSC underwent optical coherence tomography imaging (RTVue 100; Optovue Inc, Fremont, CA). En face sections at the level of the Haller layer were classified by two masked graders into five mutually exclusive morphologic categories (temporal herringbone, branched from below, laterally diagonal, double arcuate, and reticular). The relative prevalence of each Haller vessel arrangement pattern was determined for each phenotype. RESULTS Numbers of eyes examined were as follows: 154 eyes of 77 normal subjects; 41 eyes of 31 patients with acute CSC; and 39 eyes of 33 patients with chronic CSC. The mean age of participants was 44.4 ± 14.6 years for healthy subjects (M:F = 37:40), 48.5 ± 8.2 years (M:F = 24:7) for acute CSC, and 65.3 ± 13.1 years (M:F = 28:5) for chronic CSC. The relative prevalence of each Haller vessel arrangement pattern differed by phenotype. The temporal herringbone pattern was most prevalent in healthy eyes (49.2%), whereas a reticular pattern was most prevalent in eyes with acute and/or chronic CSC (combined, 48.8%). CONCLUSION A significant difference was observed in the prevalence of respective Haller vessel arrangement patterns between eyes of normal subjects and those of patients with either acute or chronic CSC. Although further study is needed to determine the mechanistic factors underlying these differences, and the hemodynamic implications, our data suggest that en face optical coherence tomography may find a formal role in choroidal disease classification.
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Affiliation(s)
| | - Kunal K Dansingani
- Truhlsen Eye Institute, University of Omaha Medical Center, Omaha, Nebraska.,Moorfields Eye Hospital, London, United Kingdom
| | - Marco Rispoli
- Centro Italiano Macula, Rome, Italy.,Nuovo Regina Margherita Hospital, Rome, Italy
| | - Gianni Virgili
- Department of Translational Surgery and Medicine, Ophthalmology, University of Florence, Careggi, Florence, Italy
| | - Alfonso Savastano
- Department of Translational Surgery and Medicine, Ophthalmology, University of Florence, Careggi, Florence, Italy
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York.,The LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York.,Department of Ophthalmology, New York University School of Medicine, New York, New York
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25
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Vupparaboina KK, Dansingani KK, Goud A, Rasheed MA, Jawed F, Jana S, Richhariya A, Freund KB, Chhablani J. Quantitative shadow compensated optical coherence tomography of choroidal vasculature. Sci Rep 2018; 8:6461. [PMID: 29691426 PMCID: PMC5915389 DOI: 10.1038/s41598-018-24577-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 04/05/2018] [Indexed: 11/09/2022] Open
Abstract
Conventionally rendered optical coherence tomography (OCT) images of the posterior segment contain shadows which influence the visualization of deep structures such as the choroid. The purpose of this study was to determine whether OCT shadow compensation (SC) alters the appearance of the choroid and the apparent choroidal vascularity index (CVI), an OCT-derived estimated ratio of luminal to total choroidal volume. All scans were shadow compensated using a previously published algorithm, binarized using a novel validated algorithm and extracted binarized choroid to estimate CVI. On 27 raw swept-source OCT volume-scans of healthy subjects, the effect of SC on CVI was established both qualitatively and quantitatively. In shadow compensated scans, the choroid was visualized with greater brightness than the neurosensory retina and the masking of deep tissues by retinal blood vessels was greatly reduced. Among study subjects, significant mean difference in CVI of -0.13 was observed between raw and shadow compensated scans. Conventionally acquired OCT underestimates both choroidal reflectivity and calculated CVI. Quantitative analysis based on subjective grading demonstrated that SC increased the contrast between stromal and luminal regions and are in agreement with true tissue regions. This study is warranted to determine the effects of SC on CVI in diseased eyes.
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Affiliation(s)
- Kiran Kumar Vupparaboina
- Surjana Center for Innovation, LV Prasad Eye Institute Hyderabad, Hyderabad, Telangana, India.,Department of Electrical Engineering, Indian Institute of Technology Hyderabad, Hyderabad, Telangana, India
| | - Kunal K Dansingani
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Abhilash Goud
- Clinical Research, LV Prasad Eye Institute Hyderabad, Hyderabad, Telangana, India
| | | | - Fayez Jawed
- Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, United States
| | - Soumya Jana
- Department of Electrical Engineering, Indian Institute of Technology Hyderabad, Hyderabad, Telangana, India
| | - Ashutosh Richhariya
- Surjana Center for Innovation, LV Prasad Eye Institute Hyderabad, Hyderabad, Telangana, India
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York, USA.,LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York, USA
| | - Jay Chhablani
- Vitreo-retinal Service, LV Prasad Eye Institute Hyderabad, Hyderabad, Telangana, India.
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26
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Dansingani KK, Gal‐Or O, Sadda SR, Yannuzzi LA, Freund KB. Understanding aneurysmal type 1 neovascularization (polypoidal choroidal vasculopathy): a lesson in the taxonomy of 'expanded spectra' - a review. Clin Exp Ophthalmol 2018; 46:189-200. [PMID: 29178419 PMCID: PMC5900982 DOI: 10.1111/ceo.13114] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 11/18/2017] [Accepted: 11/19/2017] [Indexed: 12/11/2022]
Abstract
The term aneurysmal type 1 neovascularization is derived from terminology, which is established in the literature but has fallen out of use. We believe that aneurysmal type 1 neovascularization accurately describes the lesions which define the entity known as polypoidal choroidal vasculopathy (PCV). Over the last three decades, the clinical spectrum of PCV has expanded to recognize the occurrence of the aneurysmal (polypoidal) lesions in different contexts, resulting in a complex and unwieldy taxonomy based sometimes on circumstantial findings rather than mechanistic considerations. Advances in multimodal imaging provides increasingly convincing evidence that the lesions which define various forms of PCV are indeed vascular and arise from type 1 neovascular networks. The understanding of PCV as type 1 neovascularization with aneurysms renews focus on the question as to why some patients with type 1 neovascularization develop aneurysms while others do not. Conceptual themes and potential for further study are discussed.
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Affiliation(s)
- Kunal K Dansingani
- Department of Ophthalmology, University of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
- Moorfields Eye HospitalLondonUK
| | - Orly Gal‐Or
- Vitreous Retina Macula Consultants of New YorkNew YorkNew YorkUSA
- LuEsther T. Mertz Retinal Research CenterManhattan Eye, Ear and Throat HospitalNew YorkNew YorkUSA
- Rabin Medical CenterPetah‐TikvaIsrael
| | - Srinivas R Sadda
- Doheny Eye InstituteLos AngelesCaliforniaUSA
- Department of OphthalmologyDavid Geffen School of Medicine at University of California Los AngelesLos AngelesCaliforniaUSA
| | - Lawrence A Yannuzzi
- Vitreous Retina Macula Consultants of New YorkNew YorkNew YorkUSA
- LuEsther T. Mertz Retinal Research CenterManhattan Eye, Ear and Throat HospitalNew YorkNew YorkUSA
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New YorkNew YorkNew YorkUSA
- LuEsther T. Mertz Retinal Research CenterManhattan Eye, Ear and Throat HospitalNew YorkNew YorkUSA
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27
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Tan ACS, Dansingani KK, Curcio CA, Freund KB. Author Response: The Evolution of the Plateau, an Optical Coherence Tomography Signature Seen in Geographic Atrophy. Invest Ophthalmol Vis Sci 2017; 58:6196. [PMID: 29222549 PMCID: PMC5724397 DOI: 10.1167/iovs.17-23339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Anna C S Tan
- Vitreous Retina Macula Consultants of New York, New York, New York, United States.,The LuEsther T. Mertz Retinal Research Center, New York, New York, United States.,Singapore National Eye Center/Singapore Eye Research Institute, Singapore
| | - Kunal K Dansingani
- Vitreous Retina Macula Consultants of New York, New York, New York, United States.,The LuEsther T. Mertz Retinal Research Center, New York, New York, United States.,University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Christine A Curcio
- Department of Ophthalmology, University of Alabama School of Medicine, Birmingham, Alabama, United States; and the
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York, United States.,The LuEsther T. Mertz Retinal Research Center, New York, New York, United States.,Department of Ophthalmology, New York University School of Medicine, New York, New York, United States
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28
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Barbazetto I, Dansingani KK, Dolz-Marco R, Giovannini A, Piccolino FC, Agarwal A, Lima LH, Vianna RN, Yannuzzi LA. Idiopathic Acute Exudative Polymorphous Vitelliform Maculopathy: Clinical Spectrum and Multimodal Imaging Characteristics. Ophthalmology 2017; 125:75-88. [PMID: 28844323 DOI: 10.1016/j.ophtha.2017.07.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 07/16/2017] [Accepted: 07/21/2017] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To describe clinical findings in patients with acute exudative polymorphous vitelliform maculopathy (AEPVM). DESIGN Retrospective, observational, multicenter case series review. PARTICIPANTS Consecutive patients diagnosed with idiopathic AEPVM. METHODS Review of clinical charts, multimodal imaging, electrophysiologic findings, and genetic findings in previously unpublished patients and review of the literature. MAIN OUTCOME MEASURES Clinical features of idiopathic AEPVM and differential diagnosis. RESULTS Eighteen patients (age range, 21-74 years) with typical features of AEPVM, including initial localized, serous detachments followed by the development of characteristic yellow-white deposits in the vitelliform space. Over time, this hyperautofluorescent material gravitated within the larger lesions, resulting in typical curvilinear deposits characteristic of later stages. Symptoms and clinical findings lasted from weeks to several years. Some patients showed previously undescribed features such as fluorescein-negative intraretinal cystic changes, choroidal neovascularization, serous retinal elevations mimicking retinal folds, increased choroidal thickness, lack of rapid visual recovery, and recurrence years after complete resolution of initial manifestations. CONCLUSIONS Acute exudative polymorphous vitelliform maculopathy can present with a more variable natural course than previously described. Paraneoplastic retinopathy and autosomal recessive bestrophinopathy closely resemble AEPVM, necessitating medical and hereditary evaluation to exclude these clinical possibilities. This series of patients with AEPVM expands the clinical spectrum of the disorder, including demographics, clinical manifestations, imaging features, natural course, and visual prognosis.
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Affiliation(s)
- Irene Barbazetto
- Vitreous Retina Macula Consultants of New York, New York, New York; The LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York
| | - Kunal K Dansingani
- Vitreous Retina Macula Consultants of New York, New York, New York; The LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York
| | - Rosa Dolz-Marco
- Vitreous Retina Macula Consultants of New York, New York, New York; The LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York.
| | | | - F C Piccolino
- Biostatistics Section, Department of Health Sciences, University of Genova, Genova, Italy
| | | | - Luiz H Lima
- Federal University of São Paulo, São Paulo, Brazil
| | - Raul N Vianna
- Department of Ophthalmology, Hospital Naval Marcilio Dias, Rio de Janeiro, Brazil; Department of Ophthalmology, Universidade Federal Fluminense, Niterói, Brazil
| | - Lawrence A Yannuzzi
- Vitreous Retina Macula Consultants of New York, New York, New York; The LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York
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29
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Tan ACS, Astroz P, Dansingani KK, Slakter JS, Yannuzzi LA, Curcio CA, Freund KB. The Evolution of the Plateau, an Optical Coherence Tomography Signature Seen in Geographic Atrophy. Invest Ophthalmol Vis Sci 2017; 58:2349-2358. [PMID: 28437524 PMCID: PMC5413303 DOI: 10.1167/iovs.16-21237] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose Histologic details of progression routes to geographic atrophy (GA) in AMD are becoming available through optical coherence tomography (OCT). We studied the origins and evolution of an OCT signature called plateau in eyes with GA and suggested a histologic correlate. Methods Serial eye-tracked OCT scans and multimodal imaging were acquired from eight eyes of seven patients with GA and plateau signatures over a mean follow-up of 7.7 years (range, 3.7–11.6). The histology of unrelated donor eyes with AMD was reviewed. Results Drusenoid pigment epithelial detachment (PED) on OCT imaging progressed into wide-based mound-like signatures with flattened apices characterized by a hyporeflective yet heterogeneous interior and an overlying hyperreflective exterior, similar to outer retinal corrugations previously ascribed to persistent basal laminar deposit (BLamD) but larger. These new signatures are described as “plateaus.” An initial increase of the PED volume and hyporeflectivity of its contents was followed by a decrease in PED volume and thinning of an overlying hyperreflective band attributable to the loss of the overlying RPE leaving persistent BLamD. Both imaging and histology revealed persistent BLamD with defects through which gliotic Müller cell processes pass. Conclusions Plateaus can be traced back to drusenoid PEDs on OCT imaging. We hypothesize that during progressive RPE atrophy, Müller cell extension through focal defects in the residual persistent BLamD may contribute to the heterogeneous internal reflectivity of these entities. The role of Müller cell activation and extension in the pathogenesis of AMD should be explored in future studies.
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Affiliation(s)
- Anna C S Tan
- Vitreous Retina Macula Consultants of New York, New York, New York, United States 2The LuEsther T. Mertz Retinal Research Center, New York, New York, United States 3Singapore National Eye Center/Singapore Eye Research Institute/Duke-NUS Medical School, Singapore, Singapore
| | - Polina Astroz
- Vitreous Retina Macula Consultants of New York, New York, New York, United States 4Department of Ophthalmology, Intercity Hospital and University Paris Est, Creteil, France
| | - Kunal K Dansingani
- Vitreous Retina Macula Consultants of New York, New York, New York, United States 2The LuEsther T. Mertz Retinal Research Center, New York, New York, United States 5Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska, United States
| | - Jason S Slakter
- Vitreous Retina Macula Consultants of New York, New York, New York, United States
| | - Lawrence A Yannuzzi
- Vitreous Retina Macula Consultants of New York, New York, New York, United States 2The LuEsther T. Mertz Retinal Research Center, New York, New York, United States
| | - Christine A Curcio
- Department of Ophthalmology, University of Alabama School of Medicine, Birmingham, Alabama, United States
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York, United States 2The LuEsther T. Mertz Retinal Research Center, New York, New York, United States 7Department of Ophthalmology, New York University School of Medicine, New York, New York, United States
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30
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Inoue M, Jung JJ, Balaratnasingam C, Dansingani KK, Dhrami-Gavazi E, Suzuki M, de Carlo TE, Shahlaee A, Klufas MA, El Maftouhi A, Duker JS, Ho AC, Maftouhi MQE, Sarraf D, Freund KB. A Comparison Between Optical Coherence Tomography Angiography and Fluorescein Angiography for the Imaging of Type 1 Neovascularization. Invest Ophthalmol Vis Sci 2017; 57:OCT314-23. [PMID: 27409488 DOI: 10.1167/iovs.15-18900] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To determine the sensitivity of the combination of optical coherence tomography angiography (OCTA) and structural optical coherence tomography (OCT) for detecting type 1 neovascularization (NV) and to determine significant factors that preclude visualization of type 1 NV using OCTA. METHODS Multicenter, retrospective cohort study of 115 eyes from 100 patients with type 1 NV. A retrospective review of fluorescein (FA), OCT, and OCTA imaging was performed on a consecutive series of eyes with type 1 NV from five institutions. Unmasked graders utilized FA and structural OCT data to determine the diagnosis of type 1 NV. Masked graders evaluated FA data alone, en face OCTA data alone and combined en face OCTA and structural OCT data to determine the presence of type 1 NV. Sensitivity analyses were performed using combined FA and OCT data as the reference standard. RESULTS A total of 105 eyes were diagnosed with type 1 NV using the reference. Of these, 90 (85.7%) could be detected using en face OCTA and structural OCT. The sensitivities of FA data alone and en face OCTA data alone for visualizing type 1 NV were the same (66.7%). Significant factors that precluded visualization of NV using en face OCTA included the height of pigment epithelial detachment, low signal strength, and treatment-naïve disease (P < 0.05, respectively). CONCLUSIONS En face OCTA and structural OCT showed better detection of type 1 NV than either FA alone or en face OCTA alone. Combining en face OCTA and structural OCT information may therefore be a useful way to noninvasively diagnose and monitor the treatment of type 1 NV.
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Affiliation(s)
- Maiko Inoue
- Vitreous Retina Macula Consultants of New York, New York, New York, United States 2The LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York, United States 3Yokohama City University Medical Center, Yokohama
| | - Jesse J Jung
- Vitreous Retina Macula Consultants of New York, New York, New York, United States 2The LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York, United States 4Edward S. Harkness Eye Institute, Columbia Univers
| | - Chandrakumar Balaratnasingam
- Vitreous Retina Macula Consultants of New York, New York, New York, United States 2The LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York, United States
| | - Kunal K Dansingani
- Vitreous Retina Macula Consultants of New York, New York, New York, United States 2The LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York, United States
| | - Elona Dhrami-Gavazi
- Vitreous Retina Macula Consultants of New York, New York, New York, United States 2The LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York, United States 4Edward S. Harkness Eye Institute, Columbia Univers
| | - Mihoko Suzuki
- Vitreous Retina Macula Consultants of New York, New York, New York, United States 2The LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York, United States
| | - Talisa E de Carlo
- New England Eye Center and Tufts Medical Center, Tufts University, Boston, Massachusetts, United States 7Department of Electrical Engineering and Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massa
| | - Abtin Shahlaee
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Michael A Klufas
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States 10Stein Eye Institute, Los Angeles, California, United States
| | | | - Jay S Duker
- New England Eye Center and Tufts Medical Center, Tufts University, Boston, Massachusetts, United States
| | - Allen C Ho
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | | | - David Sarraf
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States 10Stein Eye Institute, Los Angeles, California, United States
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York, United States 2The LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York, United States 12Department of Ophthalmology, New York University
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Dansingani KK, Perlee LT, Hamon S, Lee M, Shah VP, Spaide RF, Sorenson J, Klancnik JM, Yannuzzi LA, Barbazetto IA, Cooney MJ, Engelbert M, Chen C, Hewitt AW, Freund KB. Risk Alleles Associated with Neovascularization in a Pachychoroid Phenotype. Ophthalmology 2016; 123:2628-2630. [DOI: 10.1016/j.ophtha.2016.06.060] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 06/26/2016] [Accepted: 06/27/2016] [Indexed: 11/28/2022] Open
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Dansingani KK, Tan AC, Gilani F, Phasukkijwatana N, Novais E, Querques L, Waheed NK, Duker JS, Querques G, Yannuzzi LA, Sarraf D, Freund KB. Subretinal Hyperreflective Material Imaged With Optical Coherence Tomography Angiography. Am J Ophthalmol 2016; 169:235-248. [PMID: 27349411 DOI: 10.1016/j.ajo.2016.06.031] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/15/2016] [Accepted: 06/16/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The range of subretinal hyperreflective material (SHRM) seen in macular disease includes type 2 macular neovascularization, fibrosis, exudation, vitelliform material, and hemorrhage. The prognostic significance of SHRM has been evaluated retrospectively in clinical trials, but discriminating SHRM subtypes traditionally requires multiple imaging modalities. The purpose of this study is to describe optical coherence tomography angiography (OCTA) flow characteristics and artifacts that might help to distinguish SHRM subtypes. DESIGN Validity analysis. METHODS Patients with age-related macular degeneration (AMD), myopia, pachychoroid disease, and macular dystrophy, manifesting SHRM on optical coherence tomography (OCT), were recruited. Clinical chart review and multimodal imaging established the SHRM subtype. All patients underwent OCTA. OCT and OCTA images were examined together for (1) intrinsic flow, (2) retinal projection onto the anterior SHRM surface (strong, weak, absent), (3) retinal projection through SHRM onto retinal pigment epithelium (RPE), and (4) masking of choriocapillaris flow. RESULTS Thirty-three eyes of 25 patients were included (type 2 neovascularization ×3; fibrosis ×4; exudation ×10; hemorrhage ×5; vitelliform ×17). Mean age per eye was 76 years (standard deviation: 12). Intrinsic flow was strongest in type 2 neovascularization. Subretinal fibrosis showed limited flow in residual large-caliber vessels and branches. Flow was not detected within foci of exudation, hemorrhage, or vitelliform lesions. Retina-SHRM surface projection was strongest onto smooth-surfaced SHRM and weaker onto exudation. Retinal projection was weakest on the surface of vitelliform lesions. Retina-RPE projection was masked by dense hemorrhage and vitelliform material. In compound SHRM, OCTA distinguished between vascular and avascular components. CONCLUSION Optical coherence tomography angiography can distinguish vascular from avascular SHRM components. OCTA artifacts may distinguish certain avascular SHRM components.
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Zahid S, Dansingani KK, Fisher Y. Optical Coherence Tomography Evaluation of Valsalva-Induced Suprachoroidal Hemorrhage. Ophthalmic Surg Lasers Imaging Retina 2016; 47:674-6. [PMID: 27434901 DOI: 10.3928/23258160-20160707-11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 04/22/2016] [Indexed: 11/20/2022]
Abstract
Suprachoroidal hemorrhage is typically observed in patients with hypotony in the context of intraocular surgery and trauma. We report a rare presentation of suprachoroidal hemorrhage associated with emesis (Valsalva maneuver) in a myopic patient with few other identifiable risk factors. This diagnosis was confirmed with wide-field fundus photography and B-scan ultrasound and was localized to the suprachoroidal space using both enhanced depth and swept-source optical coherence tomography imaging. This case is unique in its presentation and demonstrates the utility of newer imaging techniques to localize hemorrhages using a multimodal approach. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:674-676.].
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Dansingani KK, Balaratnasingam C, Mrejen S, Inoue M, Freund KB, Klancnik JM, Yannuzzi LA. Annular Lesions and Catenary Forms in Chronic Central Serous Chorioretinopathy. Am J Ophthalmol 2016; 166:60-67. [PMID: 27021439 DOI: 10.1016/j.ajo.2016.03.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 03/10/2016] [Accepted: 03/17/2016] [Indexed: 12/31/2022]
Abstract
PURPOSE To describe a series of patients exhibiting annular retinal pigment epithelial (RPE) lesions in the context of chronic central serous chorioretinopathy. DESIGN Retrospective comparative case series. METHODS Consecutive patients with chronic central serous chorioretinopathy were identified from the clinical practices of 3 retina specialists. A subset of patients exhibiting annular RPE lesions on fundus autofluorescence was included for chart review and examination of multimodal imaging (study group). Patients with alternative etiologies for neurosensory detachment or pigment epitheliopathy were excluded. A second consecutive cohort of patients, with acute central serous chorioretinopathy, was also examined for the presence of annular lesions (comparative group). RESULTS Sixty-seven patients with chronic central serous chorioretinopathy were identified. Fourteen eyes of 12 patients exhibited annular lesions (study eyes). Mean visual acuity of study eyes was 20/27 (logMAR 0.13, SD 0.11). Annular lesions were composed of hyperautofluorescent stellate lesions arranged in an open or closed ring with intervening foci of punctate hypoautofluorescence. Optical coherence tomography showed RPE hyperplasia at the perimeters of annular lesions with loss of ellipsoid reflectivity and preserved RPE at the lesion center. Annular lesions were confined to the posterior poles and appeared to have developed at the margins of chronic neurosensory detachment. Forty-three eyes of 30 patients with acute central serous chorioretinopathy comprised the comparative group and none of these eyes exhibited annular lesions. CONCLUSIONS Annular lesions occur in up to a fifth of patients with chronic central serous chorioretinopathy but carry a relatively good visual prognosis. Curvilinear RPE figures and demarcation lines are seen in various retinal conditions but the characteristics of annular lesions described here suggest that they are specific to chronic central serous chorioretinopathy.
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Dansingani KK, Freund KB. Optical Coherence Tomography Angiography Reveals Mature, Tangled Vascular Networks in Eyes With Neovascular Age-Related Macular Degeneration Showing Resistance to Geographic Atrophy. Ophthalmic Surg Lasers Imaging Retina 2016; 46:907-12. [PMID: 26469229 DOI: 10.3928/23258160-20151008-02] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 08/07/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND OBJECTIVE To demonstrate a vascular pattern seen on optical coherence tomography angiography (OCTA) that appears to correlate with reduced rates of geographic atrophy (GA) in eyes receiving long-term anti-vascular endothelial growth factor (VEGF) treatment for neovascular age-related macular degeneration (AMD). PATIENTS AND METHODS Non-consecutive, retrospective cohort study. Patients were included if they had received more than 50 anti-VEGF injections during a period of at least 4 years for neovascular AMD in at least one eye, with absence or minimal progression of GA. Clinical charts and imaging were reviewed retrospectively; study eyes underwent OCTA. RESULTS Nine eyes of eight patients were included. Mean age was 82 years, and mean follow-up of study eyes 9.1 years; study eyes received a mean of 65.8 injections. OCTA revealed tangled networks of neovessels associated with type 1 lesions. CONCLUSION With prolonged anti-VEGF treatment, GA appears to occur less commonly in eyes with type 1 neovascularization. OCTA shows mature tangled vessels with substantial flow within type 1 lesions. Mature, tangled networks may be associated with a decreased likelihood of developing GA despite the presence of choriocapillaris atrophy.
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Abstract
PURPOSE To describe a patient who showed progression of age-related macular degeneration along the course of an underlying large choroidal vessel. METHODS Retrospective case report. RESULTS An 84-year-old woman was diagnosed with age-related macular degeneration and followed for more than 6 years. Retinal pigment epithelial changes were more advanced in her right eye which had a thinner choroid than the fellow left eye. Multimodal imaging with swept-source optical coherence tomography showed that the progression of outer retinal and retinal pigment epithelial changes appeared to follow the course of a large choroidal vessel. CONCLUSION The authors hypothesize that large choroidal vessels can compress the overlying choriocapillaris, possibly leading to outer retinal ischemia, which subsequently could focally accelerate the course of age-related macular degeneration.
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Affiliation(s)
- Maiko Inoue
- *Vitreous Retina Macula Consultants of New York, New York, NY; †The LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, NY; and ‡Department of Ophthalmology, New York University School of Medicine, New York, NY
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Abstract
PURPOSE To report a case of focal choroidal excavation and choroidal neovascularization in the setting of pachychoroid disease. METHODS Multimodal imaging, including fundus photography, fundus autofluorescence, enhanced depth imaging optical coherence tomography, indocyanine green angiography, and en face structural and angiographic optical coherence tomography. RESULTS The authors describe a 39-year-old female with moderately high myopia presenting with focal choroidal excavation and associated choroidal neovascularization. Multimodal imaging demonstrated pachychoroid features with dilated choroidal vessels surrounding the lesion. Optical coherence tomography angiography showed Type 2 neovascularization. CONCLUSION Some cases of focal choroidal excavation and associated neovascularization may be related to structural abnormalities of the associated choroidal vasculature.
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Affiliation(s)
- Quraish Ghadiali
- *Vitreous Retina Macula Consultants of New York, New York, New York; †The LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York; and ‡Moorfields Eye Hospital, London, United Kingdom
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Dansingani KK, Balaratnasingam C, Klufas MA, Sarraf D, Freund KB. Optical Coherence Tomography Angiography of Shallow Irregular Pigment Epithelial Detachments In Pachychoroid Spectrum Disease. Am J Ophthalmol 2015; 160:1243-1254.e2. [PMID: 26319161 DOI: 10.1016/j.ajo.2015.08.028] [Citation(s) in RCA: 155] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 08/19/2015] [Accepted: 08/19/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE To determine the proportion of shallow irregular pigment epithelial detachments in eyes with pachychoroid features that harbor neovascular tissue and to study the morphology of this tissue with optical coherence tomography (OCT) angiography. DESIGN Prospective consecutive cohort study. METHODS Patients with pachychoroid spectrum diagnoses and shallow irregular pigment epithelial detachment in at least 1 eye (study eye) were included. Charts and multimodal imaging were reviewed to determine a dye angiography detection rate for type 1 neovascularization in study eyes. All patients then underwent OCT angiography prospectively, followed by masked segmentation and grading. RESULTS Twenty-two eyes of 16 patients were included. Mean age was 71 (range 57-95) years. Mean subfoveal choroidal thickness was 381 μm (standard deviation: 141 μm). Four out of 22 study eyes (18%) exhibited polypoidal lesions. Dye angiography demonstrated specific features of neovascularization in 5 out of 17 eyes (29%) with suspected nonpolypoidal pachychoroid neovasculopathy. With OCT angiography, type 1 neovascular tissue was visualized in 21 out of 22 study eyes (95%). CONCLUSIONS Our data suggest that, in eyes with pachychoroid features, the finding of a shallow irregular pigment epithelial detachment on OCT has greater diagnostic value for type 1 neovascularization than previously thought and that dye angiography may underestimate the prevalence of neovascularization compared to OCT angiography.
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Affiliation(s)
- Kunal K Dansingani
- Vitreous Retina Macula Consultants of New York, New York, New York; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York; Moorfields Eye Hospital, London, United Kingdom
| | - Chandrakumar Balaratnasingam
- Vitreous Retina Macula Consultants of New York, New York, New York; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York
| | - Michael A Klufas
- Retina Division, Stein Eye Institute, University of California, Los Angeles, Los Angeles, California
| | - David Sarraf
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California, Los Angeles, Los Angeles, California
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York; Department of Ophthalmology, New York University School of Medicine, New York, New York.
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Spaide RF, Klancnik JM, Cooney MJ, Yannuzzi LA, Balaratnasingam C, Dansingani KK, Suzuki M. Volume-Rendering Optical Coherence Tomography Angiography of Macular Telangiectasia Type 2. Ophthalmology 2015; 122:2261-9. [DOI: 10.1016/j.ophtha.2015.07.025] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 06/16/2015] [Accepted: 07/22/2015] [Indexed: 01/08/2023] Open
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Dansingani KK, Suzuki M, Naysan J, Samson CM, Spaide RF, Fisher YL. Panuveitis With Exudative Retinal Detachments After Vaccination Against Human Papilloma Virus. Ophthalmic Surg Lasers Imaging Retina 2015; 46:967-70. [DOI: 10.3928/23258160-20151008-11] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 08/10/2015] [Indexed: 11/20/2022]
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Dansingani KK, Inoue M, Engelbert M, Freund KB. Optical coherence tomographic angiography shows reduced deep capillary flow in paracentral acute middle maculopathy. Eye (Lond) 2015; 29:1620-4. [PMID: 26381094 DOI: 10.1038/eye.2015.180] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 07/12/2015] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Paracentral acute middle maculopathy (PAMM) has been described as an ischemic lesion of the middle retinal layers with a characteristic lamellar hyper-reflective placoid appearance in the acute phase and thinning of the involved retinal layers in the chronic phase. Optical coherence tomographic angiography (OCTA) is a novel and non-invasive technique for imaging retinal capillary vasculature with en face segmentation capabilities. METHOD Case series. We describe two patients with PAMM who underwent clinical examination and multimodal imaging including OCTA. RESULTS In the first patient, who presented with PAMM secondary to acute cilioretinal artery occlusion, OCTA demonstrated reduction in flow in the deep capillary plexus (DCP). One month later, OCTA revealed a flow void due to thinning of the GCL, INL, and OPL and paradoxical apparent ONL thickening. Similar findings of focal retinal lamellar ectopia were seen in the second patient, who had an incidentally detected chronic PAMM lesion. CONCLUSIONS OCTA images the superficial and deep capillary plexi independently. PAMM is characterized by acute and chronic attenuation of the DCP flow signature. Focal lamellar ectopia in PAMM is discussed.
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Affiliation(s)
- K K Dansingani
- Vitreous Retina Macula Consultants of New York, New York, New York, USA.,LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York, USA.,Moorfields Eye Hospital, London, UK
| | - M Inoue
- Vitreous Retina Macula Consultants of New York, New York, New York, USA.,LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York, USA
| | - M Engelbert
- Vitreous Retina Macula Consultants of New York, New York, New York, USA.,LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York, USA.,Department of Ophthalmology, New York University School of Medicine, New York, New York, USA
| | - K B Freund
- Vitreous Retina Macula Consultants of New York, New York, New York, USA.,LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York, USA.,Department of Ophthalmology, New York University School of Medicine, New York, New York, USA.,Department of Ophthalmology, North-Shore Long Island Jewish Health System, Manhasset, New York, USA
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Dansingani KK, Naysan J, Freund KB. Silicone Oil Confined Within a Lamellar Macular Hole as Demonstrated by En Face Swept Source Optical Coherence Tomography. JAMA Ophthalmol 2015; 133:e15112. [PMID: 26158439 DOI: 10.1001/jamaophthalmol.2015.112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Kunal K Dansingani
- Vitreous Retina Macula Consultants of New York, New York2The LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York 3Moorfields Eye Hospital, London, United Kingdom
| | - Jonathan Naysan
- Vitreous Retina Macula Consultants of New York, New York2The LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York 4Department of Ophthalmology, New York University School of Medicine, New York
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York2The LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York 4Department of Ophthalmology, New York University School of Medicine, New York
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Dansingani KK, Freund KB. Paracentral Acute Middle Maculopathy and Acute Macular Neuroretinopathy: Related and Distinct Entities. Am J Ophthalmol 2015; 160:1-3.e2. [PMID: 26054463 DOI: 10.1016/j.ajo.2015.05.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 05/02/2015] [Accepted: 05/04/2015] [Indexed: 10/23/2022]
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Abstract
CONTEXT Breast cancer is the most common malignancy in women, with increasing incidence in Europe and North America. The frequency of involvement of the eye and visual pathways is reported to be as high as 30% in patients with known metastatic disease. In some cases, ophthalmic involvement can be the first sign of metastatic spread. Metastasis occurs via the haematogenous route and predominantly involves the choroid. Metastases to other ocular structures, the orbit and the visual pathways have also been described. Paraneoplastic effects are rare but significant. TREATMENTS Different modalities are employed in the treatment of breast cancer and its metastases. These include chemotherapy and radiotherapy. The ocular adverse effects of these have been well described, but recently developed new treatment modalities, such as monoclonal antibodies, may have different side-effects. With the increasing incidence of breast cancer and the advent of new treatment strategies, the complications of the disease and the sequelae of therapy are highly relevant to both oncologists and ophthalmologists.
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Dansingani KK, Al-Khaier A, Russell-Eggitt IM, Nischal KK. Management of intracorneal bleb after trabeculectomy for congenital glaucoma. Cornea 2005; 24:486-8. [PMID: 15829811 DOI: 10.1097/01.ico.0000148292.68501.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Congenital glaucoma is a well-recognized entity that can occur in the presence of anterior segment dysgenesis. Trabeculectomy is an accepted intervention in the management of congenital glaucoma. The surgical technique as well as complications is well described. METHODS This is a case report of a 3-month-old girl with anterior segment dysgenesis and glaucoma. She was referred post-trabeculectomy with persistent corneal opacity to be considered for penetrating keratoplasty and was found to have intrastromal corneal bleb. RESULTS Ultrasound biomicroscopy confirmed communication of the corneal bleb with the anterior chamber, and the bleb was treated by autologous blood injection at the trabeculectomy site, under acetazolamide cover. CONCLUSIONS We present evidence suggesting that abnormal structure was the etiologic basis for corneal bleb formation and describe our management of this previously unreported complication of trabeculectomy.
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